SB 100-SUBSTANCE ABUSE/MENTAL HEALTH PROGRAMS  CHAIR MCGUIRE announced the consideration of SB 100. 9:15:21 AM JOHNNY ELLIS, Alaska State Legislature, Sponsor of SB 100, said Senator Bunde had earlier asked the daily cost for patients in the non-secure "detox" facility, and that is yet to come. The number of calls regarding "high flyers" in Anchorage is forthcoming as well. The question of whether a person must hit rock bottom before treatment can be effective is answered in studies that he has provided to the committee. He said the bill goes to finance committee next, and the main rub will be the costs of the pilot project. The bill will need broad support in the body, he surmised. 9:17:14 AM SENATOR STEVENS noted that he received a letter saying that Senator Ellis should be the first one committed. SENATOR ELLIS said that person corresponds frequently with the legislature and has feelings about conspiracies. He said everyone is entitled to their opinions. There is a misunderstanding; the bill will use an existing statute, and judges, not politicians, will commit people. It is for the most extreme cases and he has taken time to educate people. CHAIR MCGUIRE said she has had constituents in favor of involuntary commitment. One has had tremendous difficulty getting a family member committed, she stated. SENATOR ELLIS said it is often family members that ask for help getting someone committed, and the statute should be stronger. He said the American Civil Liberties Union would likely oppose the legislation if the bill changed the balance of power. "If people perceive that someone is out to get them or that the system is totally corrupt and people are after them…I've heard from two individuals that have concerns that this bill might pass and someone might try to involuntarily commit them. I've gone to great pains to explain to people it is extreme circumstances that we're talking about." 9:20:23 AM SENATOR FRENCH noted a handout with a cost and health comparison of babies born to untreated and treated substance-abusing women. For the one-week treatment for substance abuse, the average savings to the system was over $30,000 per birth [because the babies were born larger and healthier and their stay in the hospital was shortened]. Looking at it from a purely economic standpoint-without even considering the long-term consequences of being a small baby--the system is money ahead, he stated. CHAIR MCGUIRE said the part of the bill she likes is putting pregnant women at the top of the treatment list. She thought that was already the mandate and didn't know the state wasn't following it. It is two lives being impacted. It is not 100 percent, but the hope is the mother can be treated and the baby benefits, she said. SENATOR ELLIS said federal grants require priority for pregnant women, but the state doesn't for its grants. The bill would make it clear in state statute. One discussion got caught up in an abortion debate, he said, and "I hope we've transcended that." 9:23:16 AM CHAIR MCGUIRE said whether a person is pro-life or pro-choice, it is in everybody's best interest. SENATOR BUNDE clarified that giving pregnant women priority treatment doesn't mean they will be sent involuntarily. SENATOR ELLIS said there is a committee substitute (CS). SENATOR GREEN moved to adopt the CS for SB 100, labeled 25- LS0151\N, as the working document. Hearing no objection, Version N was before the committee. BILL HOGAN, Deputy Commissioner, Department of Health and Social Services (DHSS), said he was once with the Division of Behavioral Health. The change made by the CS is simple and mandates that DHSS coordinates with existing community resources to ensure an adequate number of trained crisis responders and medical and legal support. 9:25:45 AM MR. HOGAN said there are many aspects of the bill that DHSS feels strongly about, including identifying people with co- occurring disorders. Up to 70 percent of people receiving services have co-occurring disorders. The department is working on an integrated behavioral health service delivery system, and SB 100 supports those efforts. He said he likes the focus on evidence-based practice and the use of research to determine the most effective services. Some federal block-grant money has been used on evidence-based practices lately, and this will reaffirm that focus. He said he likes focusing on outcomes. Just being sober is not good enough; "we really want folks to be productive and contributing members of society." He supports the pilot project for involuntary commitment. He has worked with a lot of individuals forced into treatment, and it is not necessary that they have hit rock bottom to be successful. Forcing treatment really helps people achieve sobriety and maintain it, he stated. 9:28:29 AM CHAIR MCGUIRE said it will particularly help people whose family members and friends are involved due to their love for them. SENATOR STEVENS assumed the fiscal note includes the needed personnel. But the CS speaks to existing community resources. He asked, "What are we buying for $2 million?" KATE HERRING, Staff to Senator Ellis, said the first version discussed the pilot program coordinating with community resources, and the program should fund its own staff, but the department was concerned that it would need to extend community service patrols and policing. "We basically inserted the word 'existing.'" The intent is to clarify no expansion. 9:30:45 AM SENATOR FRENCH said the bill doesn't change the legal standards for involuntary commitment. The difference is being committed to a treatment program instead of a mental institution. MS. HERRING said yes. She understands that the involuntary commitment statute was underutilized because there was no where to put people who were incapacitated by their addiction. SENATOR ELLIS said he has been impressed with the Department while working on this legislation, and they are willing to try something new. The legislature has been frustrated with money put into treatment programs that sound good, but it takes longitudinal studies and statistical reporting beyond simply intuition or hope to know the results. So evidence-based programming is the way the country is going, because policy makers are sick and tired of investing in programs that don't work. The legislature was shocked to find that the D.A.R.E. program is not a good investment. "We all stood there, had our photos taken with the kids and the canine units and the police." It seemed to be a good program, but studies showed it didn't work. He said we are not giving up on young people but trying to put money in things that truly work. He understands that one would want a program to have an 80 or 90 percent success rate. Maybe 45 percent is the best to expect, he said. "But we don't know unless we require that these programs that we invest our public dollars in are evidence-based." That way there will be no flying in the dark on good intentions, he concluded. CHAIR MCGUIRE said the big decision will be made on the fifth floor. She said she doesn't know how much money they have. 9:34:15 AM SENATOR ELLIS said he is committed to work with all senators to get the bill through. This is a partnership, and he is calling everyone to the table to help whittle down the legislative fiscal note. The status quo has gone on too long with a ridiculous waste of money, he said. 9:35:33 AM SENATOR BUNDE said the bill is sound, but he is disappointed that the Mental Health Trust won't support it. It is a general fund responsibility. Mandated treatment does not work in the state, he said. Looking at $2 million for only 20 people a year is not a gamble he is willing to take. It might speed the bill up to take out the financial implication, he stated. He moved Amendment 1 to remove Section 8, the pilot program. SENATOR FRENCH objected because it guts the bill and leaves nothing but a wish list. The real test of the bill is if the state can save money and save lives by intensive treatment for people with co-occurring disorders. Senator Bunde doesn't think the programs work, but there is a study by Johns Hopkins that a period as short as one week can save the system $30,000 by focusing on pregnant women. There is evidence that is does work. 9:38:22 AM SENATOR ELLIS encouraged the committee to not adopt the amendment. If the bill moves, "we would have the opportunity to work with all the parties, and discussions are ongoing." The Mental Health Trust is supportive, and he is telling them to put money in. The bill will have to satisfy the body and the finance committee. There are other sources of money as well, he stated. If the pilot project is left in the bill, the finance committee is where people can come to the table. If that doesn't work, it won't pass. Please give him the chance to work on it, he asked. SENATOR BUNDE said the care for pregnant women doesn't involve involuntary commitment, so there is value in the bill without Section 8. Section 8 is just a gamble; there is no evidence until $11 million is spent, he stated. 9:40:06 AM CHAIR MCGUIRE said she shares some of his concerns but she will let the idea go to the finance committee. Innovation may be needed to get the repeat folks that cost so much money. It is a big bite for the state, especially when trying to figure our fiscal stability. Section 8 is a big part of the bill, she said. A roll call vote was taken on Amendment 1. Senator Bunde voted in favor, and Senators French, Green, Stevens, and McGuire voted against. Amendment 1 failed on a vote of 1 to 4. SENATOR FRENCH moved the CS for SB 100, labeled 25-LS0151\N, Mischel, from committee with individual recommendations and accompanying fiscal notes. SENATOR BUNDE objected. He said there were some good ideas in the bill but the price tag is far too high. A roll call vote was taken. Senators French, Green, Stevens, and McGuire voted in favor of moving the CS and Senator Bunde voted against. Therefore CSSB 100(STA) moved from committee on a vote of 4 to 1. 9:42:26 AM