Legislature(2009 - 2010)HOUSE FINANCE 519

02/04/2010 09:00 AM House FINANCE

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09:10:03 AM Start
09:10:39 AM HB300 || HB302
02:58:14 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to 1:30 pm Today --
Heard & Held
Heard & Held
+ Alaska Mental Health Trust Authority TELECONFERENCED
HOUSE BILL NO. 300                                                                                                            
     "An Act making appropriations for the operating and                                                                        
     loan program expenses of state government, for certain                                                                     
     programs, and to capitalize funds; making supplemental                                                                     
     appropriations; making appropriations under art. IX,                                                                       
     sec. 17(c), Constitution of the State of Alaska; and                                                                       
     providing for an effective date."                                                                                          
HOUSE BILL NO. 302                                                                                                            
     "An Act making appropriations for the operating and                                                                        
     capital    expenses   of    the   state's    integrated                                                                    
     comprehensive mental health program; and providing for                                                                     
     an effective date."                                                                                                        
9:10:39 AM                                                                                                                    
ALASKA MENTAL HEALTH TRUST AUTHORITY                                                                                          
DR. WILLIAM  DOOLITTLE, CHAIRMAN, BOARD OF  TRUSTEES, ALASKA                                                                    
MENTAL HEALTH TRUST AUTHORITY,  introduced the Alaska Mental                                                                    
Health Trust Authority (AMHTA) staff  members present in the                                                                    
9:12:35 AM                                                                                                                    
Representative Kelly commented  on the excellent credentials                                                                    
of Dr. Doolittle.                                                                                                               
Co-Chair  Stoltze  thought that  the  AMHTA  Board was  very                                                                    
professional and he voiced appreciation for them.                                                                               
Co-Chair Hawker shared similar sentiments.                                                                                      
JEFF JESSEE,  CHIEF EXECUTIVE OFFICER, ALASKA  MENTAL HEALTH                                                                    
TRUST  AUTHORITY,   admitted  that   the  AMHTA   staff  was                                                                    
impressive  and  high performing.  He  turned  to a  handout                                                                    
entitled,  "House  Finance  Committee FY  2011  Budget".  He                                                                    
began with slide 2, listing the Trust beneficiaries.                                                                            
Mr. Jessee  listed the Trust  advisors as shown on  slide 3.                                                                    
He discussed the Trust funding  - slide 4. He emphasized the                                                                    
cooperation between, and alignment  with, state agencies. He                                                                    
referred  to the  annual report,  which is  included in  the                                                                    
members' packets.  He referred  to page  8, which  shows how                                                                    
the Trust has fared in weathering the economic storm.                                                                           
Mr.  Jessee clarified,  at  Co-Chair  Hawker's request,  the                                                                    
Trust's  involvement with  the Permanent  Fund. The  Trust's                                                                    
cash funds  are invested by the  Permanent Fund Corporation.                                                                    
The Trust's funding  for 2010 is only about  10 percent less                                                                    
than it previously  was in 2008. It is predicted  to be flat                                                                    
in 2011.  It is one  of the most resilient  foundation funds                                                                    
in the country.                                                                                                                 
9:19:56 AM                                                                                                                    
Mr. Jessee described joint FY  2011 legislative priorities -                                                                    
slide 5.  He reported  a plan to  increase the  adult dental                                                                    
Medicaid reimbursement  cap and  to establish a  regular and                                                                    
periodic schedule  of rate reviews  for home  and community-                                                                    
based services.  Other priorities  are to support  a 10-year                                                                    
plan  to  reduce  homelessness,  and to  fund  a  community-                                                                    
coordinated transportation system.                                                                                              
Co-Chair  Stoltze shared  his experience  with AMHTA  in his                                                                    
district, such as the partnership  with the Boys' and Girls'                                                                    
Club.  Mr.  Jessee  related AMHTA's  attempt  to  work  with                                                                    
9:24:47 AM                                                                                                                    
Mr. Jessee  identified AMHTA's formula  for success  - slide                                                                    
6. It involves identifying  the problem, bringing experts to                                                                    
the  table, and  developing focused  strategies. The  entire                                                                    
effort must be monitored and data driven.                                                                                       
9:26:48 AM                                                                                                                    
Representative Kelly asked whether  churches are involved in                                                                    
collaboration with  AMHTA. Mr.  Jessee spoke  of Faith-Based                                                                    
Initiatives  such as  the Salvation  Army  and the  Covenant                                                                    
House currently in the system.  He agreed that more could be                                                                    
done to approach religious  organizations for help. Co-Chair                                                                    
Hawker  suggested Mr.  Jessee add  churches to  the list  of                                                                    
collaborators. Mr.  Jessee agreed that  was a good  idea and                                                                    
stressed that AMHTA  could use the help. He was  open to all                                                                    
9:29:54 AM                                                                                                                    
Mr. Jessee  described the five  program focus areas  - slide                                                                    
7. There are two objectives; one  is to give the committee a                                                                    
general idea of what is to  be accomplished and the other is                                                                    
related to budget recommendations.                                                                                              
Mr.  Jessee shared  information  about Bring  the Kids  Home                                                                    
program -  slide 8. He referred  to a flyer included  in the                                                                    
members  packet entitled,  "Alaska  Continues  to Bring  the                                                                    
Kids Home" (copy on file).  He noted an opportunity for more                                                                    
people to be involved.                                                                                                          
9:32:22 AM                                                                                                                    
Co-Chair Hawker  noted the  irony that a  meeting was  to be                                                                    
held at a church.                                                                                                               
Co-Chair Stoltze  asked if  there was  a long-term  plan for                                                                    
the Eklutna  facility. Mr.  Jessee related  that one  of the                                                                    
cornerstones of  Bring the Kids  Home (BTKH) is to  keep the                                                                    
children in  their Native communities. There  is 100 percent                                                                    
Medicaid reimbursement  for BTKH.  The original plan  was to                                                                    
build  cottages  in  Eklutna; however,  it  was  deemed  not                                                                    
practical and not  cost effective. The decision  was made to                                                                    
redesign  the building  and  put it  on  the Native  Medical                                                                    
Center campus.  The project  has been  cancelled due  to the                                                                    
cost projected by South Central  Foundation. The state could                                                                    
not guarantee it could meet those costs.                                                                                        
9:37:19 AM                                                                                                                    
Co-Chair Stoltze expressed his disappointment.                                                                                  
Mr. Jessee  returned to  the discussion  of BTKH,  which was                                                                    
started in  FY 06. He termed  it one of the  most successful                                                                    
initiatives the  Trust has undertaken. He  shared statistics                                                                    
about  attendance  and  cost.  It  was  felt  that  in-state                                                                    
services  would save  money and  that has  turned out  to be                                                                    
true.  Slide   9  shows  projected  BTKH   reinvestment.  He                                                                    
projected a phase-out of BTKH by  2013 if "the game plan" is                                                                    
maintained. He stressed the importance of the investment.                                                                       
9:41:12 AM                                                                                                                    
Mr. Jessee shared results for  beneficiaries - slide 10. The                                                                    
Residential Psychiatric  Treatment Center  (RPTC) recidivism                                                                    
rate  has gone  from 20  percent to  3.4 percent.  Returning                                                                    
youth home and ensuring quality were successful goals.                                                                          
Representative  Austerman requested  more information  about                                                                    
waning support  for community-based issues. Mr.  Jessee said                                                                    
the  next  slide  held that  information.  He  continued  to                                                                    
explain the reasons behind the  successes of BTKH. The Trust                                                                    
invested  hundreds  of  thousands  of  non-Medicaid  dollars                                                                    
originally  for individualized  services. The  idea was  not                                                                    
popular, but turned  out to be very successful.  Less than 1                                                                    
percent of  kids who  have received  individualized services                                                                    
funds have  ended up  in higher level  RPTC care.  He shared                                                                    
examples of the kinds of services provided.                                                                                     
9:44:49 AM                                                                                                                    
Mr. Jessee  turned to  the FY  2011 budget  - slide  11. The                                                                    
Trust continues  to provide support  for BTKH.  He described                                                                    
the differences  between what the Trust  recommended and the                                                                    
governor's budget. He mentioned  the challenges and the need                                                                    
to be successful in funding.                                                                                                    
Co-Chair Hawker  asked if  General Fund/Mental  Health funds                                                                    
are incremental.  Mr. Jessee said they  were incremental. He                                                                    
added that it is the  Trust's view that it means reinvesting                                                                    
the dollars  saved that would go  to out-of-state placement.                                                                    
Co-Chair  Hawker  concluded that  no  ground  was lost  from                                                                    
previous investments. Mr. Jessee said that was correct.                                                                         
9:46:43 AM                                                                                                                    
Representative  Salmon asked  what  the tribal/rural  system                                                                    
development  funding   was.  Mr.  Jessee  replied   that  it                                                                    
consists   of   giving   seed   money   to   tribal   health                                                                    
organizations so  that they can  start to plan  their system                                                                    
of care.                                                                                                                        
Representative Doogan  asked why the differences  in the two                                                                    
columns were there. Mr. Jessee  said it was due to financial                                                                    
constraints, not a philosophical difference.                                                                                    
Representative Kelly pointed out  that some requests require                                                                    
continued funding.  He approved of the  funding mechanism of                                                                    
AMHTA. The  presentation helps to understand  excellence and                                                                    
the need to support it.                                                                                                         
9:50:17 AM                                                                                                                    
Mr. Jessee added another metaphor.                                                                                              
Co-Chair  Hawker agreed  with Representative  Kelly. Several                                                                    
years ago the Trust was too far  ahead and now it is back on                                                                    
9:51:40 AM                                                                                                                    
Representative   Gara   spoke    of   agency   pressure   on                                                                    
legislators.  He appreciated  the methodology  of AMHTA.  He                                                                    
wondered  about  the  cost of  the  Behavior  Rehabilitation                                                                    
Services  (BRS) rate  increase, the  early childhood  mental                                                                    
health  increase, foster  parent/parent  services, and  peer                                                                    
navigation.  He  wondered about  the  impacts  of not  fully                                                                    
funding those items.                                                                                                            
Mr. Jessee explained the BRS  service, which are group homes                                                                    
that OCS operates.  The quality of care  or overall capacity                                                                    
will decline if  not fully funded; however,  there would not                                                                    
be dire  consequences in 2011.  There will be  pressure over                                                                    
time to maintain quality services with costs increasing.                                                                        
Mr. Jessee spoke of foster parent  service as not as high of                                                                    
a priority. Peer  navigation will be an  important item down                                                                    
the  road. It  involves parents  and kids  mentoring others.                                                                    
Early childhood  mental health  is new,  but important  as a                                                                    
prevention tool. It receives some Trust money.                                                                                  
9:57:35 AM                                                                                                                    
Representative  Gara  asked  if peer  navigation  and  early                                                                    
childhood  mental health  funds go  to actual  services. Mr.                                                                    
Jessee  responded that  peer navigation  funds  do not,  but                                                                    
early childhood funds do.                                                                                                       
Co-Chair Stoltze  spoke of natural resources  assets and the                                                                    
public concern about  environmental issues outweighing human                                                                    
needs. He emphasized the  importance of developing resources                                                                    
in order  to achieve goals.  Mr. Jessee  spoke of a  plan to                                                                    
exchange Trust lands. He maintained  that there is more than                                                                    
one  way to  accommodate different  interests and  achieve a                                                                    
goal. The Trust is developing other ways to grow the Trust.                                                                     
AT EASE        10:02:37 AM                                                                                                    
RECONVENED     10:04:16 AM                                                                                                    
Representative Kelly concurred with Co-Chair Stoltze.                                                                           
Vice-Chair Thomas did not agree  with taking public lands in                                                                    
exchange  for  wilderness  lands.  He  noted  he  represents                                                                    
Prince of Wales  land and would like to see  jobs created on                                                                    
timber lands. He suggested maximizing Trust land use.                                                                           
Vice-Chair Thomas  asked if the Mental  Health General Funds                                                                    
increments  are  one-time  requests. Mr.  Jessee  said  they                                                                    
would go into the base.  Vice-Chair Thomas thought the total                                                                    
of that column was about $3.8 million.                                                                                          
10:07:20 AM                                                                                                                   
Mr.  Jessee turned  to  slide 12  -  disability justice.  He                                                                    
spoke  of the  difficulties and  strategies of  dealing with                                                                    
incarcerated  beneficiaries.  Co-Chair Hawker  restated  the                                                                    
problem of  working with the  inmates and wondered  how many                                                                    
have  addiction problems.  Mr. Jessee  replied  that a  very                                                                    
large  percentage have  addiction problems.  Co-Chair Hawker                                                                    
opined that it  would be difficult to  address the substance                                                                    
abuse issue. Mr.  Jessee agreed that it is  a large problem.                                                                    
Co-Chair   Hawker  suggested   addressing  substance   abuse                                                                    
prevention  objectives.  Mr.  Jessee  shared  the  two  main                                                                    
themes related to incarceration; housing and addiction.                                                                         
10:10:12 AM                                                                                                                   
Mr.   Jessee  discussed   the  strategic   thinking  between                                                                    
cooperating entities - slide 13.  He returned to slide 12 to                                                                    
make a point about limited housing options.                                                                                     
Co-Chair Hawker  asked for further information  about item 3                                                                    
on slide 13  - reducing the use of jails  as described under                                                                    
Title 47.  He asked what  was needed to protect  people from                                                                    
Mr.  Jessee mentioned  there were  three  issues related  to                                                                    
Title 47.  One is  mental health  commitments. The  state of                                                                    
Alaska  has  requirements  if  a   person  is  a  danger  to                                                                    
themselves or to the community.  Another Title 47 commitment                                                                    
is  the  alcohol  commitment,   which  entails  a  different                                                                    
process.  The  care  and  custody  in  that  instance  is  a                                                                    
provider  or  organization.  The   big  resistance  to  that                                                                    
commitment  example  is  that  the  state  is  obligated  to                                                                    
provide the  services and  many end up  filling up  jails in                                                                    
the case of alcohol holds.                                                                                                      
Co-Chair Hawker inquired what the unduplicated count was.                                                                       
10:15:49 AM                                                                                                                   
Mr. Jesse remarked  that the unduplicated count  may be very                                                                    
high, but may be just "one-time".                                                                                               
Co-Chair  Hawker mentioned  the  success  of Senator  Ellis'                                                                    
pilot project.                                                                                                                  
Co-Chair  Stoltze remarked  on  the  "thousands" number.  He                                                                    
wondered  if  it  referred  to  a number  of  people  or  to                                                                    
Mr. Jesse remarked  that it is both. There  are thousands on                                                                    
hold  and many  come in  duplicate times.  In Anchorage  and                                                                    
Fairbanks,  the facilities  can identify  those who  come in                                                                    
multiple times. This requires one  kind of strategy. In some                                                                    
areas it might be people coming in for the first time.                                                                          
10:18:45 AM                                                                                                                   
Representative Kelly  was watching  carefully the  Cliff Row                                                                    
program.  He  believed that  the  holds  are too  short  for                                                                    
mental health and alcohol and  something needs to be done to                                                                    
provide longer  help. The  Cliff Row  center effort  sends a                                                                    
strong message  for mandatory holds.  He blamed  the liberal                                                                    
lawyers for not letting the community help those people.                                                                        
10:22:36 AM                                                                                                                   
Co-Chair Hawker shared Representative Kelly's passion.                                                                          
Mr.  Jessee spoke  of frustrations  about lack  of long-term                                                                    
treatment  facilities.   He  spoke   of  a  pledge   to  get                                                                    
residential beds in place.  Representative Kelly referred to                                                                    
slide  10  and  the   importance  of  showing  results  from                                                                    
programs.  He  was  willing  to  provide  more  funding  for                                                                    
programs that work.                                                                                                             
Dr.  Doolittle addressed  the issue  of  alcoholism and  the                                                                    
need  to   emphasize  the  alcoholic's  inability   to  make                                                                    
reasonable decisions.                                                                                                           
Representative  Gara recalled  the  history  of support  for                                                                    
substance abuse  treatment services.  He did not  know where                                                                    
the  needs were  currently  for treatment  beds. Mr.  Jessee                                                                    
replied that  the Trust is  nowhere near where they  need to                                                                    
be.  The   need  is  not   more  prominent  in   the  budget                                                                    
recommendations because  it is a  huge problem and  it would                                                                    
take more  of a focused  effort by  more than the  Trust. He                                                                    
reported  on   the  staggering  costs  to   the  state  from                                                                    
substance abuse. It will require  a partnership to solve the                                                                    
10:28:42 AM                                                                                                                   
Representative  Gara emphasized  that  he  is serious  about                                                                    
finding a  solution. He requested more  information in order                                                                    
to  advocate. He  thought  it  was insane  that  there is  a                                                                    
waiting list at the heroin  treatment facility. He wanted to                                                                    
know the gap  between what is being done and  what should be                                                                    
done. Mr. Jessee offered to work on the issue.                                                                                  
Co-Chair Hawker  recalled the history  of BTKH, the  pace of                                                                    
investment,  and outcomes.  That  mission was  accomplished.                                                                    
The  legislature put  critical resources  into developmental                                                                    
disability   resources.   He    maintained   that   critical                                                                    
priorities  were  determined and  funded.  He  saw that  the                                                                    
topic  may now  be  chemical addiction  and  noted that  the                                                                    
legislature is willing to help.                                                                                                 
10:33:40 AM                                                                                                                   
Representative  Doogan  inquired  how many  Alaskan's  would                                                                    
have  to  be  "dried  out"   to  end  the  problem  and  how                                                                    
successful  might  that  be. Mr.  Jessee  shared  statistics                                                                    
about who  needed treatment:  ages 12-17  - 1000;  adults 18                                                                    
and older - 20,000. The question  is how many can be helped.                                                                    
He suggested  a focused  effort with  partnerships involved.                                                                    
He  added  that sexual  assault  and  domestic violence  are                                                                    
directly related. He  held those examples out as  a place to                                                                    
Representative  Doogan suggested  if the  number of  alcohol                                                                    
abusers  could be  cut  in  half, a  certain  amount of  the                                                                    
budget could be eliminated. He  was looking for a reasonable                                                                    
goal. Mr.  Jessee reported that  a target is needed.  He did                                                                    
not think that looking at  the large numbers would work, but                                                                    
rather a specific goal should be identified.                                                                                    
10:39:42 AM                                                                                                                   
Representative  Doogan  thought  that  more  of  the  budget                                                                    
should be  spent on  a definite  path. He  wanted to  have a                                                                    
direction to proceed.                                                                                                           
Co-Chair  Hawker had  a hard  time with  the statistics  Mr.                                                                    
Jessee provided.  He thought alcohol was  involved in crimes                                                                    
committed  90 percent  of the  time. Mr.  Jessee agreed.  He                                                                    
commented  that it  is hard  to describe  the road  when you                                                                    
don't know where you want to go.                                                                                                
10:43:14 AM                                                                                                                   
Representative  Kelly   spoke  of  his  experience   on  the                                                                    
Corrections Subcommittee. He  reported 60 percent recidivism                                                                    
in prisoners,  and 92 percent  are incarcerated as  a result                                                                    
of chemical  abuse issues.  He believed  that jobs  were the                                                                    
answer.  He suggested  spending money  on programs  that are                                                                    
Vice-Chair  Thomas spoke  of  domestic  violence and  sexual                                                                    
assault being related to jobs.  He opined that jobs are lost                                                                    
during land exchanges. He suggested developing mines.                                                                           
10:49:38 AM                                                                                                                   
Representative  Salmon related  that he  comes from  a small                                                                    
village that  has a  high alcoholism  rate, and  he believed                                                                    
that  lack   of  jobs  is   a  factor.  He   suggested  that                                                                    
rehabilitation is successful only  if the person wants help.                                                                    
He also thought self-worth was very important.                                                                                  
Dr. Doolittle thought the Trust  was sensitive to jobs being                                                                    
important for  rehabilitation. Housing  programs incorporate                                                                    
a job element into the programs.  He agreed that there is an                                                                    
emotional element, but  sometimes it is not  known what will                                                                    
work to turn addiction around. He  said it is a problem that                                                                    
needs to be solved.                                                                                                             
10:56:29 AM                                                                                                                   
Co-Chair  Hawker  wished  to   hear  the  remainder  of  the                                                                    
presentation at 1:30.                                                                                                           
Representative Kelly mentioned  that committee members value                                                                    
this information.                                                                                                               
10:59:44 AM    RECESSED                                                                                                       
1:44:18 PM     RECONVENED                                                                                                     
Co-Chair  Hawker reconvened  the  overview  with the  Mental                                                                    
Health Trust Authority.                                                                                                         
1:46:59 PM                                                                                                                    
Mr. Jessee  continued with the  disability justice  area. It                                                                    
breaks down  into 3 phrases:  keep the beneficiaries  out of                                                                    
the correctional system, determine what  to do when they are                                                                    
in correctional facilities, and what  can be done to prevent                                                                    
them from coming back into the correctional system.                                                                             
Mr. Jessee  referred to  slide 14  - Therapeutic  Courts. He                                                                    
pointed out  that therapeutic courts  are very  effective at                                                                    
keeping people  from entering  the criminal  justice system.                                                                    
He  shared   a  story.   He  encouraged  people   to  attend                                                                    
therapeutic  court  sessions.  The court  supervises  people                                                                    
throughout the entire program, not  just when sentenced. The                                                                    
program works  better as a  positive experience  when people                                                                    
recognize their achievements.                                                                                                   
1:50:46 PM                                                                                                                    
Representative Gara  suggested that money needs  to be spent                                                                    
where it  is actually doing  some good.  He asked if  it was                                                                    
true  that therapeutic  courts would  be  more effective  if                                                                    
there were more treatment services available.                                                                                   
Mr.  Jessee  agreed  that  it   was  true.  More  money  for                                                                    
substance  abuse  services  would help  therapeutic  courts.                                                                    
Money is  now being given  to the  courts to help  fund this                                                                    
treatment goal.  Therapeutic courts  should not be the place                                                                    
someone needs  to go for  treatment. There needs to  be more                                                                    
money and help before a crime is committed.                                                                                     
Representative  Gara  asked if  the  proposed  money in  the                                                                    
budget is sufficient. Mr. Jessee  believed it sufficient for                                                                    
FY 2011.                                                                                                                        
1:54:01 PM                                                                                                                    
Mr.  Jessee referred  to  the  Adult Guardianship  Mediation                                                                    
project as  a way to  get people  out of the  Superior Court                                                                    
System through mediation.                                                                                                       
Mr. Jessee  showed on slide 15  what was ahead for  FY 2011.                                                                    
Trust  assets  will  be  used   for  training  programs  for                                                                    
criminal   justice   personnel,   to  sustain   and   expand                                                                    
therapeutic models and  practices, for transitional planning                                                                    
for   beneficiaries,   and   to  develop   alternatives   to                                                                    
incarceration  for  beneficiaries   who  require  protective                                                                    
Representative Kelly  asked if  there were also  state funds                                                                    
allocated for therapeutic courts.                                                                                               
Mr.  Jessee  replied that  the  next  page would  show  that                                                                    
information.    There    is    base    funding    for    the                                                                    
Anchorage Mental Health Court.                                                                                                  
Co-Chair  Hawker   inquired  if  slide  15   shows  proposed                                                                    
incremental  funding for  FY 2011.  Mr. Jessee  replied that                                                                    
slide  15  shows FY  2011  Trust  funded elements.  Co-Chair                                                                    
Hawker asked if  it is new money. Mr.  Jessee explained that                                                                    
some of it is a continuation of FY 2009 funds.                                                                                  
Co-Chair Hawker  remarked that some  is for  maintenance and                                                                    
some  is   new  money.   He  wondered  which   state  agency                                                                    
administers the  funds. Mr. Jessee  explained that a  lot is                                                                    
managed   through  the   Department   of  Corrections,   the                                                                    
Department  of Health  and Social  Services, and  the Alaska                                                                    
Court System.                                                                                                                   
Co-Chair  Hawker commented  that it  seems like  the funding                                                                    
crosses state  agency lines. He  suggested that it  would be                                                                    
good to have all allocations  for therapeutic courts under a                                                                    
central administration.                                                                                                         
1:59:27 PM                                                                                                                    
Mr.  Jessee agreed  with  that. To  be  successful with  the                                                                    
initiative,  many  different  agencies need  to  be  brought                                                                    
together,  so  a  point person  would  be  helpful.  Program                                                                    
officers have fulfilled  that role and the  court system has                                                                    
done a good job implementing the court regime.                                                                                  
Mr. Jessee moved to slide 16,  which shows some of the GF/MH                                                                    
requests:   sustain  and   expand  therapeutic   models  and                                                                    
practices, transitional planning  for beneficiaries involved                                                                    
with the  criminal justice system, and  develop alternatives                                                                    
to  incarceration for  beneficiaries who  require protective                                                                    
custody. Services  need to  be added to  the budget  to stop                                                                    
Mr. Jessee  brought up the  Bethel Project as an  example of                                                                    
how to  develop alternatives  to incarcerations  under Title                                                                    
47. He  hoped to get this  fully funded. The goal  is to get                                                                    
people  out of  jail  and  out of  the  emergency room.  The                                                                    
Bethel Project is a high priority.                                                                                              
2:03:14 PM                                                                                                                    
Representative Salmon  questioned the difference  in success                                                                    
rate  between regular  courts  and  therapeutic courts.  Mr.                                                                    
Jessee  replied   that  therapeutic  courts  are   far  more                                                                    
successful. He offered to provide the data.                                                                                     
2:04:11 PM                                                                                                                    
Mr. Jessee  continued to slide  17 -  Workforce Development.                                                                    
He  noted the  difficulty  in getting  and retaining  health                                                                    
care staff. There  are more than 20 partners  working in the                                                                    
workforce  area. He  focused on  the strategic  thinking and                                                                    
the  key   focus  areas  in  workforce   development.  Often                                                                    
supervision and support are key to job retention.                                                                               
Mr.  Jessee referred  to results  for beneficiaries  on page                                                                    
18. He  listed training throughout Alaska  of professionals,                                                                    
students  and  participants.  The  goal is  to  help  people                                                                    
progress through professions, so  more than entry level jobs                                                                    
are offered.                                                                                                                    
2:07:20 PM                                                                                                                    
Mr. Jessee moved to slide 19,  looking ahead to FY 2011. One                                                                    
of the  goals is to  begin a psychiatric  residency program.                                                                    
He talked  about the  need to replace  those that  leave the                                                                    
mental health  profession and to  stop those that  come into                                                                    
the system for temporary or short-term work.                                                                                    
Co-Chair Hawker  said he knew  a person who wanted  to start                                                                    
residential  psychiatric   training.  He  wondered   if  the                                                                    
program would start in 2011.                                                                                                    
Mr. Jessee said the program  is just in the awareness phase,                                                                    
and  will not  be starting  next year.  He reported  that he                                                                    
sees tremendous  support throughout  the field  for starting                                                                    
the  program.   There  are  other  providers   who  will  be                                                                    
contributing money, which will require less state funding.                                                                      
Co-Chair Hawker agreed the program  needs to be grounded and                                                                    
awareness raised  in order  to make  the program  happen. He                                                                    
felt  expectations  needed to  be  managed  at a  reasonable                                                                    
2:11:18 PM                                                                                                                    
Representative  Austerman  saw   problems  with  conflicting                                                                    
state  and federal  laws regarding  mental health  services.                                                                    
There are  people who would  like to move forward,  but they                                                                    
are hindered by federal and state regulations.                                                                                  
Mr. Jessee  asked if Representative Austerman  was referring                                                                    
to income  and resource limits. Some  federal programs allow                                                                    
income  sheltering,  but  it continues  to  be  problematic.                                                                    
Medicaid  coverage could  be lost  if people  earn too  much                                                                    
money.   Some  federal   rules   are   a  limiting   factor.                                                                    
Representative  Austerman asked  if  there  was a  solution.                                                                    
Mr.  Jessee  said  there  may  be some  aid  in  the  public                                                                    
assistance arena.  The primary  health insurance  program is                                                                    
Medicaid, which requires maintaining eligibility.                                                                               
Representative Austerman  commented that so many  cases deal                                                                    
with  people who  just need  help  with finding  a job,  but                                                                    
their diagnosis gets in the way.                                                                                                
2:15:05 PM                                                                                                                    
Mr. Jessee  agreed it was  a frustrating situation.  He said                                                                    
that in  order to  be able  to be  served in  the behavioral                                                                    
health  system  in  Alaska,  clients  need  to  follow  many                                                                    
federal rules.  That applies to  Medicaid services,  as well                                                                    
as to domestic violence and sexual assault services.                                                                            
Mr. Jessee  continued with slide 19  and discussed expanding                                                                    
student loan  repayment and  other incentive  strategies for                                                                    
professionals,  implementing  a   clinical  PhD  program  in                                                                    
psychological   internship   in   Alaska,   and   supporting                                                                    
increments  of UA  health programs  to continue  progress in                                                                    
workforce development.                                                                                                          
2:18:08 PM                                                                                                                    
Mr.  Jessee  talked about  slide  20  regarding the  Trust's                                                                    
commitment  in the  recruitment and  retention of  qualified                                                                    
employees, and in training and education goals.                                                                                 
Mr. Jessee  referred to slide  21, which is about  trying to                                                                    
get the  state to  help with developing  workforce capacity.                                                                    
There  is not  much  success  shown in  these  areas in  the                                                                    
existing governor's budget. Without  qualified people to run                                                                    
them, there is no reason to fund programs.                                                                                      
Co-Chair Hawker  remarked that many agencies  talk about how                                                                    
important jobs are to individuals.  He wanted to know if the                                                                    
right  priorities were  being funded.  He questioned  if the                                                                    
focus should be on funding jobs.                                                                                                
Mr. Jessee  believed that  the majority  of people  who work                                                                    
for   mental    health   programs   are    not   necessarily                                                                    
beneficiaries.  He  clarified  that   the  funding  for  job                                                                    
training   was   for   the   workforce   that   works   with                                                                    
beneficiaries.  He  noted that  there  were  many people  in                                                                    
recovery  who work  in the  field; however,  there is  not a                                                                    
direct relationship to the qualified workforce.                                                                                 
2:22:47 PM                                                                                                                    
Representative Joule  asked about  beneficiaries who  try to                                                                    
get work.  He wondered if  past crime history is  a negative                                                                    
factor.  Mr.  Jessee agreed  it  was  a significant  problem                                                                    
because it  is hard  to get  a job if  you have  committed a                                                                    
crime. It  becomes difficult to find  employment and housing                                                                    
for  those  who  have  committed a  felony.  Sometimes  DHSS                                                                    
waivers are effective.                                                                                                          
Representative  Joule noted  that  addiction counselors  who                                                                    
have  overcome  past addictions  make  a  big difference  to                                                                    
those they serve. Mr. Jesse agreed.                                                                                             
2:25:34 PM                                                                                                                    
Mr. Jessee  continued with slide  22 -  obtaining affordable                                                                    
and appropriate housing. It is  a difficult problem, but has                                                                    
shown some  of the  greatest successes.  The problem  is the                                                                    
large  numbers of  homeless people  in  Alaska. The  fastest                                                                    
growing  homeless  population  is  families  with  children.                                                                    
There are  8,000 people discharged from  corrections without                                                                    
any  identifiable  housing   arrangement.  He  stressed  the                                                                    
significance of that statistic.                                                                                                 
Co-Chair   Hawker   asked   for  help   understanding   that                                                                    
statistic.  Mr.  Jessee  explained   that  the  question  of                                                                    
whether the 8,000 people had  housing was not asked of them;                                                                    
however, the expectation was that  the situation is probably                                                                    
not the best for long-term success.  There is a need to work                                                                    
with that  population to find  good housing so they  are not                                                                    
as likely  to fall  back into addiction  or crime.  Many are                                                                    
showing up in shelters.                                                                                                         
Co-Chair Hawker questioned the term "discharge planning".                                                                       
2:29:26 PM                                                                                                                    
Co-Chair  Hawker brought  up prison  demographics and  noted                                                                    
that  40  percent  of  the  prison  population  was  Alaskan                                                                    
Native,  and a  better discharge  plan was  needed for  that                                                                    
Representative  Joule  remarked   that  upon  discharge,  if                                                                    
mandatory substance abuse programs  have not been completed,                                                                    
and those services  are not offered at  home, Alaska Natives                                                                    
may  be  released to  Anchorage  where  there is  no  family                                                                    
Vice-Chair Thomas  referred to the "blue  ticket" which sent                                                                    
discharged people  to another community. Often  the homeless                                                                    
are  ignored. He  mentioned that  many homeless  are Vietnam                                                                    
veterans who do not admit they have a problem.                                                                                  
Mr.  Jessee  listed  the   Trust's  committed  partners  and                                                                    
strategic  thinking plans  for  solving  housing issues.  He                                                                    
spoke  of the  "three-legged  stool"  of housing  solutions;                                                                    
support  service funding,  operational support,  and capital                                                                    
Mr. Jessee  returned to  the topic  of frequent  abusers. He                                                                    
maintained  that there  is a  simple solution:  find housing                                                                    
for them.  This solution has  proven to be effective  in the                                                                    
Lower  48 when  other fixes  didn't work.  The most  notable                                                                    
example  of  success in  Alaska  is  in Anchorage  with  the                                                                    
purchase  of  a motel  which  would  offer housing  to  this                                                                    
2:39:22 PM                                                                                                                    
Representative Kelly did not see  a happy ending in this. He                                                                    
was worried  about the problem  of providing  public housing                                                                    
to people who don't own it  and therefore don't take care of                                                                    
it.  He  would like  to  see  more  progress before  he  can                                                                    
support  public  housing  as  an  option.  He  thought  that                                                                    
sometimes  suffering would  help motivate  people more  than                                                                    
giving  them  too  much.  He  believed  that  poverty  is  a                                                                    
powerful motivator.                                                                                                             
2:42:54 PM                                                                                                                    
Mr.  Jessee  turned to  slide  23  to  look at  results  for                                                                    
beneficiaries of the  Bridge Home program.   The graph shows                                                                    
good  results in  dramatic reductions  in admissions  to the                                                                    
Alaska Psychiatric  Institute (API),  in readmission  to the                                                                    
Department  of Corrections  (DOC), and  a reduction  in days                                                                    
spent in API  and in DOC. All beneficiaries  are not created                                                                    
equal, but results can be  delivered by providing housing to                                                                    
men  in their  40's to  50's who  are chronically  addicted,                                                                    
medically  and  intellectually   compromised,  and  severely                                                                    
damaged  in many  ways. Otherwise,  the  result is  probably                                                                    
death. The community will pay one  way or the other if these                                                                    
people are not helped.                                                                                                          
2:45:49 PM                                                                                                                    
Co-Chair Hawker had similar  concerns about providing public                                                                    
housing. He did  not want to create  an attractive lifestyle                                                                    
for addicted persons.                                                                                                           
Representative  Gara  commented  that the  legislature  must                                                                    
make decisions based  on the greatest need  and the greatest                                                                    
merit. Mr. Jessee must advocate  for the most sympathetic to                                                                    
the least sympathetic  people. Representative Gara expressed                                                                    
concern that  transitional housing for the  more sympathetic                                                                    
will   be   jeopardized   by   the   unpopularity   of   the                                                                    
unsympathetic people.  He concurred  with Mr.  Jessee's work                                                                    
on the Housing First program.                                                                                                   
Mr. Jessee  thought it was  time to try  something different                                                                    
for the chronic  population that is not going  away. Many in                                                                    
Anchorage  just want  to cut  their losses  and get  on with                                                                    
helping this population.                                                                                                        
2:51:24 PM                                                                                                                    
Co-Chair  Hawker mentioned  that some  Anchorage politicians                                                                    
are willing to  look at this process out  of desperation and                                                                    
not  because  they  support  it.   Mr.  Jessee  agreed.  The                                                                    
situation is viewed as a sense of desperation.                                                                                  
Representative Gara  remarked that a  lot of money  spent on                                                                    
something may  not equal  a great success.  He brought  up a                                                                    
concern  about   putting  this  kind  of   housing  into  an                                                                    
established  neighborhood. Mr.  Jessee asked  Representative                                                                    
Gara   to   find   an  acceptable   place   it   could   go.                                                                    
Representative Gara  countered that  it should  not go  in a                                                                    
residential  area.  Mr.  Jessee   offered  to  continue  the                                                                    
discussion later.                                                                                                               
2:55:14 PM                                                                                                                    
Mr.   Jessee    turned   to   slide   25    showing   budget                                                                    
recommendations. He  stressed that he was  very pleased with                                                                    
funding  support from  AHFC and  OMB for  the base  Homeless                                                                    
Assistance Program.                                                                                                             
Mr. Jessee  moved to slide  26 - Trust  Beneficiary Projects                                                                    
Initiative. The goal  is to prove up, over  time, the "value                                                                    
added" of beneficiary-driven programs.  He looked forward to                                                                    
working toward ending domestic violence and sexual assault.                                                                     
2:58:14 PM                                                                                                                    
Representative  Fairclough  mentioned   that  meetings  were                                                                    
being  held throughout  the state  on domestic  violence and                                                                    
sexual  assault, along  with mental  health issues.  All key                                                                    
players  at the  highest level  will come  together to  help                                                                    
bring  solutions to  this issue  together. The  governor and                                                                    
other legislators will also  participate. She requested help                                                                    
and support from all Alaskans.                                                                                                  
HB  300 and  HB 302  were heard  and HELD  in Committee  for                                                                    
further consideration.                                                                                                          

Document Name Date/Time Subjects
Mental Health Trust Presentation Overview.pdf HFIN 2/4/2010 9:00:00 AM