SB 302-DEFINITION OF MENTAL HEALTH PROFESSIONAL  MS. SHEILA PETERSON, staff to Senator Gary Wilken, said that she would read the sponsor statement for Senator Wilken who was needed to make a quorum in another committee. SB 302 is a mental health professional definition bill. It recognizes the growth of the clinical mental health profession; it broadens the mental health professional definition to include licensed clinical social workers, licensed marital and family therapists, and a licensed professional counselor. The current Title 47 definition was written in 1981, prior to the passages of Alaska's licensing requirements governing these master level mental health clinicians. SENATOR COWDERY asked if that was in 1981 or 1986. MS. PETERSON explained there was a revised sponsor statement that was provided March 21. Originally, Senator Wilken thought the year was 1986 but upon further research found it was 1981. She then continued reading the sponsor statement. A more inclusive mental health professional definition increases the capacity of Alaska's mental health system to protect our youth and adults who are experiencing acute psychiatric crises in our communities. Today, not enough mental health professionals are authorized under the current definition to respond to some critical public safety situations, particularly in rural Alaska, and yet there are hundreds of licensed professionals who are qualified to aid these Alaskans but cannot, as they do not fall within the current statutory definition. SB 302 recognizes this problem and updates the Title 47 definition. The expanded mental health professional definition as stated in SB 302 increases the number of trained professionals: who will be allowed to provide mental health treatment for prisoners; authorized to evaluate children and minors in custody; to determine placement in residential treatments; required to report incidences of harm to vulnerable adults and allowed to conduct civil commitment evaluations. MS. PETERSON informed committee members that Ms. Anne Henry from the Department of Health and Social Services was present to answer questions if necessary. [SENATOR WILKEN arrived.] SENATOR THERRIAULT asked about the proposed committee substitute. MS. PETERSON said the sponsor statement addressed the committee substitute. CHAIRMAN TAYLOR asked if the proposed committee substitute was adopted. MS. PETERSON said it was not. SENATOR COWDERY moved to adopt Version J as the committee substitute for SB 302. CHAIRMAN TAYLOR announced that without objection, Version J was adopted as the committee substitute. SENATOR WILKEN noted that Anne Henry and others were available to answer questions. MS. ANNE HENRY, Division of Mental Health and Developmental Disabilities, Department of Health and Social Services (DHSS), told members that when the definition of mental health professional was originally written, it included all of the recognized professions at the time. She explained that an evaluation for civil commitment determines whether a person is suicidal, homicidal, or gravely disabled at that moment. When a clinician decides in favor of civil commitment, the clinician gets concurrence from the psychiatrist on duty at the time and then calls a judge, who makes the final decision about commitment to hospitalization where the person would be evaluated by a staff psychiatrist. The law allows people who are employed by community mental health centers around the state to do civil commitment evaluations. They receive state funding for emergency services for mental health crisis situations. Of about 900 licensed professionals in Alaska now, only about 140 people work for those agencies. Those are the people who this bill applies to. DHSS is finding that agencies all over the state are having difficulty hiring and retaining people of that level of professionalism. She noted that since the law was originally written, the legislature has recognized licensure clinical social workers, marriage and family therapists, and professional counselors. Every one of those professions has the statutory authority to diagnose, which is what is done in an evaluation situation. She told members that SB 302 is supported by DHSS, the Alaska Mental Health Authority, the Association of Mental Health Consumers in Alaska and the Alaska Community Mental Health Services Association. SENATOR WILKEN referred to a chart in members' packets and said it provides a visual explanation of what the bill will do. CHAIRMAN TAYLOR took public testimony. MS. SHARON BULLOCK, a licensed clinical social worker and director of the Fairbanks Community Mental Health Center, affirmed the Center has had difficulty hiring people straight out of graduate school. The Center will have difficulty if SB 302 is passed as is because the way it is written, only people with a license or those with 24 months of experience after graduate school can do the screenings. In Fairbanks, when someone files a Title 47, the court gives it to the Center who sends someone out to do the screening. The screener makes recommendations to the court and the judge makes the final decision. The Center needs to have enough employees who are eligible to help with the screenings. TAPE 02-15, SIDE B MS. BULLOCK said she supports part of the bill that being that an employee could be supervised by a licensed clinical worker. She suggested shortening the 24-month requirement to 12 months. CHAIRMAN TAYLOR informed Ms. Bullock that the committee substitute before members provides for a 12-month period of work experience in the field of mental illness post Masters degree. MS. BULLOCK thanked Chairman Taylor for the update. MR. WAYNE MCCOLLUM, a licensed clinical social worker and the Community Support Program Director at the Fairbanks Community Mental Health Center, stated support for the legislation and said he shares the same concerns that Ms. Henry and Ms. Bullock expressed. He said it is very difficult to recruit and retain qualified individuals in the Interior and in rural communities. SB 302 will allow the Center to recruit a wider pool of individuals to perform an important service. CHAIRMAN TAYLOR noted there was no one else who wished to testify on SB 302 but the committee received a letter from Phillip Baker, a licensed clinical psychologist from Anchorage, which he read into the record: My name is Phillip Baker, Licensed Clinical Psychologist and Executive Director of the Alaska Psychological Association. I am writing on behalf of the Executive Staff of our association who voted unanimously to oppose SB 302 and we urge you to oppose this bill also. We are aware of the need for qualified and trained mental health professionals to work in remote communities. We were informed that SB 302 was created to help meet that need. The bill proposes to add Licensed Marriage and Family Therapists, Licensed Professional Counselors and an unlicensed mental health worker under supervision. We feel this is the wrong solution to the shortage of qualified mental health workers in rural settings. Professional Counselors, Marriage and Family Therapists and unlicensed counselors have one or two academic courses in assessment and evaluation, inadequate training for the tasks required. The unlicensed mental health worker under supervision that is mentioned in this bill would be a great liability to the State and to vulnerable mental health consumers. There is no way to regulate the practices of these particular mental health practitioners and no way for consumers to seek recourse for inept, unethical and poorly trained practices. Who would want their family members, friend or loved one's mental health needs determined by a poorly trained and unregulated provider of these important and very personal services? We urge you to return this bill to the Department of Health and Social Services and inform them that SB 302 is an inadequate solution to their problem and it increases the danger that vulnerable Alaskans will be mistreated. CHAIRMAN TAYLOR asked for a response to those comments. SENATOR WILKEN said he believes Mr. Baker's concern about the supervision of an unlicensed person has been taken care of in the committee substitute. MS. HENRY explained the current statute allows any Masters level social worker with experience in the field to do civil commitment evaluations. The committee substitute raises the qualifications to a Masters level degree plus 12 months of experience and a six- month internship. These professionals will be supervised by a licensed professional, although that is not required by the current statute. They must also be in the process of getting licensed so their dedication to becoming licensed provides more accountability. She noted that currently about eight PhD psychologists work with emergency services throughout the state. DHSS believes that most of those people work in a supervisory capacity and do not actually do the evaluations themselves so the work is being done by people who do not actually meet the definition in SB 302. CHAIRMAN TAYLOR pointed out that committee members received several other letters. SENATOR COWDERY said that he received letters from two constituents who were concerned about the letter of intent that accompanies HB 343. MS. HENRY explained that letter of intent pertains to the extension of the licensed professional counselor sunset date and asks that the boards be combined and has nothing to do with SB 302. SENATOR ELLIS commented that he voted no on similar legislation that passed through the committee last year because he received an overwhelming amount of letters from people who express concern about how careful the state should be in the area of civil commitments because to deny a person their freedom or civil liberties for any period of time is an awesome power. He asked Ms. Henry to walk him through the civil commitment process and to describe the minimum credentials of a professional who would be permitted to do an evaluation. MS. HENRY asked that Stacie Kraly answer that question. MS. STACIE KRALY, Assistant Attorney General, Department of Law, informed members that she does the civil commitments for Southeast Alaska. She said she would defer to Ms. Henry to describe the clinical part of the civil commitment process. She explained that the process works in Juneau in the following way. An individual who is in crisis is, either through a family member, a police officer or a concerned community member, usually brought to a hospital for a medical evaluation. If it appears the individual is decompensating and suffering from a mental illness, a clinical person is called in. An emergency services worker from the Juneau Alliance for the Mentally Ill goes to the hospital to conduct an evaluation of the individual in consultation with a physician and sometimes a psychiatrist. An evaluation can take up to four hours to determine whether the individual meets the statutory criteria for a commitment; that being whether the individual is mentally ill and as a result is a threat to self or others or is gravely disabled. If the individual meets the statutory criteria, the clinician meets with a psychiatrist to make sure the assessment is accurate. The clinician then calls the judicial officer and makes a recommendation and explains the reasons behind the recommendation, i.e., the individual is suicidal or was brandishing a knife in McDonald's. The judge then determines whether to commit that person for 72 hours. If so, the judge issues an ex parte order and the individual is transferred from the emergency room to the mental health ward at the hospital. Over the next 72 hours, the individual is evaluated every 24 hours by a clinician, psychiatrist, and social worker at the hospital. Within those 72 hours they are either released if they no longer meet the criteria, they may volunteer to stay longer, or the Department of Law can file a petition for a 30 day commitment whereupon the Department goes to court, presents evidence and calls witnesses, and the judge determines whether the individual should be committed for up to 30 days. CHAIRMAN TAYLOR asked Ms. Kraly to address Senator Ellis's question about the minimum qualifications allowed for a clinician under SB 302. MS. KRALY said that statewide, in rural communities, the minimum level could be pretty low. Statutorily the lowest level would be an unlicensed social worker who is not supervised. In Juneau, a few PhDs do this work. CHAIRMAN TAYLOR asked how that would change under SB 302. MS. KRALY replied that it would remain the same in the sense that there would be the added qualifications of intending to be licensed, having 12 months of supervision and clinical experience. SENATOR ELLIS asked if passage of the bill will increase the qualification requirements of the lowest level person. MS. KRALY replied, "Most definitely." SENATOR ELLIS said he appreciated the explanation about Juneau, although he is concerned about villages like Chevak or Kaktovik. MS. KRALY said the process is basically the same everywhere so that if an individual was being committed in Hoonah or Craig, a village public safety officer would call a judge and provide the information and the judge would order that the individual be transferred to an evaluation facility in either Ketchikan, Sitka or Juneau where the process would start over. If there is a mental health professional in a rural village, he or she would initiate the proceedings. SENATOR ELLIS said his concern is that SB 302 dramatically expands the number of people who can participate in this process, yet the qualifications will be higher, not lower. MS. HENRY explained that SB 302 expands the disciplines that are recognized as being licensed and, in terms of those people that are not licensed, it requires them to have a certain level of experience, including the Masters degree. Currently, any social worker with a Masters degree, whether trained clinically or not, can do a civil commitment. A good portion of people who did civil commitments in the past did not have clinical education. She repeated the bill will require a Masters degree, 12 months of field experience, and working toward being licensed. The pool will be expanded because it includes all of the different licensed disciplines. SENATOR ELLIS asked if the impact will be an improvement in the quality of the work done or whether it will just increase the number of people who can do civil commitments. MS. HENRY said she believes both will increase. She noted that she recently spoke with the director of the mental health center in Galena who said Galena has had no VPSO for six months, there are two troopers who could participate but they cover an area the size of Oregon, and she is not qualified to participate. The troopers have told her that unless someone has a knife, gun or rope in their hands, they will not get involved because they have more urgent priorities. Ms. Henry said if no one in the community is qualified, individuals end up in jail or being sent home with family members who don't know what to do. She noted that the Alaska Psychiatric Institute has reported that it gets an inappropriate number of people come in to be committed so they are sent back, a traumatic and expensive experience. She said she believes SB 302 will provide greater access to those people who really need services in a time of crisis and with Alaska's high suicide rate, the need is critical. SENATOR THERRIAULT said he received a lot of feedback on last year's civil commitment bill but most of the people who wrote were under the mistaken assumption that individuals would be able to commit themselves. He asked what level of scrutiny the judges use to make these determinations. MS. KRALY said under the ex parte order it is similar to a probable cause situation. For a 30-day commitment or anything further, the standard is clear and convincing evidence on the part of the state in the form of expert testimony by a psychiatrist. SENATOR THERRIAULT commented the scrutiny is fairly loose for the initial 72 hours but anything after that is more rigorous. MS. KRALY said that if, at any time during the 72-hour evaluation period, the individual no longer meets the statutory criteria, the individual must be released. She noted that very few individuals are sent to a 30-day commitment hearing; most people are released or go voluntarily. SENATOR COWDERY asked Ms. Kraly if her recommendations have ever been denied by the court. MS. KRALY said yes, occasionally. She said the judges she works with in the First Judicial District are very aware of the liberty interests at stake and take these cases very seriously. They do not grant 30-day commitments with any joy. SENATOR COWDERY asked Ms. Kraly if she has denied the recommendation of another. MS. KRALY said that is an interesting question because many of these petitions are based upon medical expertise and she certainly would defer to a psychiatrist who believes that a petition should go forward. However, there have been instances in which she has questioned whether or not the petition is appropriate, so she has questioned some of the petitions she has seen but generally she defers to the experts. MS. HENRY added that the standard in the mental health profession is to do whatever is the least restrictive, given the particular situation. She said she is aware of situations where clinicians have had to come up with alternatives to keep the individual safe because the individual does not quite fit the statutory criteria. CHAIRMAN TAYLOR maintained that because of the arduousness of the task, it is probably easier to charge a person with a criminal act so it is important to get the best people involved. He added that Joe Juneau was successful in establishing the mine in Juneau. His family was concerned about his activities and wanted to take over his mine. In the Territorial Days, if 10 friends and neighbors signed a petition, you went before a judge and the judge would decide whether you should be committed. Mr. Juneau was committed to a mental institution and his family took over the business. Several years later, Mr. Juneau returned to Juneau with a certificate declaring that he was safe. Chairman Taylor found it ironic that no one else in the town could be declared to be safe. Chairman Taylor noted we have come a long way and thanked the sponsor and DHSS staff for their efforts. SENATOR ELLIS said he appreciates the work done on the bill also. He noted that the people who contacted him last year did not seem to be misguided about who had the power to do a civil commitment. Their main point seemed to be that the people who do the initial evaluations have a lot of influence in the process. He said he believes SB 302 is moving in a good direction and that he will have to trust professional judgment about the balances this bill strikes. He asked participants to keep in mind that the goal is to increase the quality of mental health professionals. He noted that the lack of funding in rural areas and difficulty in providing decent coverage across the state should not be used as an excuse to change the laws. He said that does not appear to be the reason for SB 302 but it is of concern. CHAIRMAN TAYLOR said with no further testimony or comments, he would entertain a motion. SENATOR COWDERY moved to pass SB 302 from committee with individual recommendations. There being no objection, the motion carried.