Project Jukebox

Digital Branch of the University of Alaska Fairbanks Oral History Program
Jeff Jessee, Interview 2, Part 2

This is a continuation of the interview with Jeff Jessee by Bill Schneider and Karen Brewster on December 1, 2010 at Elmer E. Rasmuson Library on the University of Alaska Fairbanks campus. 

Digital Asset Information

Archive #: Oral History 2006-15-28_PT.2

Project: Alaska Mental Health Trust History
Date of Interview: Dec 1, 2010
Narrator(s): Jeff Jessee
Interviewer(s): Bill Schneider, Karen Brewster
Transcriber: Carol McCue
Location of Interview:
Funding Partners:
Alaska Humanities Forum, Alaska Mental Health Trust Authority
Alternate Transcripts
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Slideshow
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Sections

Section 1: The Mental Health Trust’s role in developing a skilled, professional workforce in the field of mental health services.

Section 2: The need for safe and affordable housing for beneficiaries, and some of the problems that beneficiaries face with the current housing program.

Section 3: Setting up a model housing program in Alaska based upon what the Gates Foundation did in Washington with their Sound Families program.

Section 4: The challenges in providing housing for the chronic alcoholic population and controversy over requiring sobriety before housing or housing first and then dealing with other issues.

Section 5: The Mental Health Trust helping to establish a Housing First project in Anchorage based upon a successful program in Seattle, and how this type of program works well for their beneficiaries.

Section 6: Working to reduce the out of state population of children in residential psychiatric treatment programs and establishing the Bring the Kids Home Initiative.

Section 7: The Mental Health Trust investing in infrastructure of the Bring the Kids Home Initiative, and encouraging the Alaska State Legislature to invest in in-state mental health services.

Section 8: Success of the Mental Health Trust partnering with the Alaska State Legislature to support improved in-state services, using the example of helping new group homes with start-up costs.

Section 9: Changes in the mental health system for helping children.

Section 10: The uneasy relationship between the Mental Health Trust and the Alaska State Legislature, and the balance of funding that the Trust manages and uses to support programs.

Section 11: Evaluation of the Mental Health Trust by beneficiaries, and their understanding of the difference between the Trust and state programs.

Section 12: Some challenges facing the Mental Health Trust where they have not accomplished as much as they would have liked, for example helping beneficiaries within the corrections system.

Section 13: Explanation of some details of the therapeutic courts.

Section 14: The importance of foundations engaging and partnering with government for sustainable funding of programs, and how the Mental Health Trust is a unique model.

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Transcript

Section 1: BILL SCHNEIDER: And we were just talking about the therapeutic courts. And there were some other things about the Trust that we were ‑‑
JEFF JESSEE: And we talked about beneficiary projects. And then another area that the trustees decided to focus on is workforce development. It's a huge issue across all beneficiary groups, workforce development. Even if we had unlimited resources, we don't have the skilled workers in the state to provide the services that our beneficiaries need.

And so the ability of agencies to expand their capacity is limited by their access to a qualified and available workforce.
So we partnered with the University of Alaska, Department of Labor, and other entities to develop a more focused effort around not only training and educating people about the opportunities of a career in our system of care, but also assisting agencies in recruitment and retention.

So, for example, we run ads on TV showing people who have worked in the field and how rewarding they have found it, and ‑‑ and tried to encourage people to ‑‑ to be interested in this area. In fact, one of them has a returning veteran who came back from Iraq, left the service and went into this field, and talks about how satisfying that is.

We are working right now on loan repayment programs so that we can create incentives that agencies can offer to professionals to get them to accept employment, you know, these kinds of strategies to try to improve our access to a qualified workforce.

Section 2: Another area that we've worked very hard on is housing. Again, like workforce, housing crosses all of our beneficiary groups. No matter what your ‑‑ your mental health disability, if you don't have safe, affordable, permanent housing, then you're not going to be successful.

And in fact, many of our beneficiaries, even if they get housing, they need support in order to maintain that housing. And what we discovered as we looked into this is that this was a systemic problem, and it works kind of like this.
The people that develop housing, the housing developers and the housing funders, like Alaska Housing Finance Corporation, by and large don't know much about support services for beneficiaries.

And so they can build the building and build the housing, but if they put our beneficiaries in and they are not provided any supports, then they often lose that housing, either because nobody's helping them manage their funds so they can pay the rent; they have poor refusal skills, and so their buddies all come over and create a problem, and the beneficiary gets evicted.

I mean, all kinds of various problems can occur.
In addition, even if they get, say, a housing voucher, which is basically a ticket that you get from AHFC that helps pay part of your rent, the normal system is you have to take that around to landlords and try to find a landlord that will accept this as payment for your rent.

Well, first of all, our beneficiaries aren't really very good at that. I mean, that takes kind of some skills to sort out, well, where do I go and how do I approach this landlord, and ‑‑ you know. And, of course, then, the landlords may notice that you have a disability, and suddenly, they don't have a vacancy. And ‑‑ and so that's an issue.

Section 3: On the service side, if you look at, say, our behavioral health centers or our senior centers, or whatever, well, they understand support services, but they don't know much about a housing development. They are not developers, they are not in the housing building business, so a lot of our work has been to bring these two groups more together so that they are working with each other.

And let me just give you one example.
AHFC had a program for a number of years, a Special Needs Housing Grants, call them SNHG , SNHG grants. And it provided what you would expect from AHFC, which is basically capital money to build housing. And very few of our beneficiary service agencies ever applied for the money.

And the reason was that if all they got was the capital money, then they couldn't figure out how to pay the operating costs of the housing, keep the lights on, keep the heat on, and they couldn't figure out how to pay for the support services because just having the housing didn't generate any income, and a lot of those services are Medicaid billable.

And so we started looking around and saying, well, who ‑‑ who has addressed this issue before? I mean, you're probably hearing this as a common theme. We don't come up with too many spontaneously brilliant ideas. Most stuff we steal from somebody.

And so we started asking around and we found out that the Gates Foundation in Seattle had invested $70 million over 10 years in a program called Sound Families. And it was designed to deal with this exact problem. It was designed to connect what we call the three legs of the stool: the capital money, the operating funds, and the support service funding.

And so what we did, and again, this comes back to the ability of the Trust to spend money without a legislative appropriation, we gathered a group of folks from Alaska that came from the service provider end, from AHFC, from the housing developers, and we got them all and we went down to Seattle.

And the Gates Foundation was just incredibly helpful in setting up a two‑day housing tour. And we met with the head of the Seattle housing agency, we went to Olympia and met with the legislators that had championed partnering with the Gates Foundation on this initiative, we learned from them what their challenges had been and how they worked around them, and ‑‑ and basically, were able to start to formulate a vision of how one could, again, connect these things all together.

Of course, now, the challenge was how are we going to get the legislature to support this? I mean, you know, this is bigger than the Trust. I mean, when you get into housing, you're talking serious money.
And it was going to be, you know, hard for us to be the prime mover on this, although we did fund several initial pilot projects, again, to establish that this was a doable, effective strategy.

Well, when we started to go to the legislature, what we did is we called the Gates Foundation and the ‑‑ the program director that we'd been working with, his name was David Wertheimer, and we asked him if he would come to Juneau and present to the legislature what their success had been in Seattle with this model of housing, this supported housing model.

And it was very interesting, because the Gates Foundation is like many foundations in that they tend not to want to get involved in anything that looks political, for all kinds of reasons, and it actually took David quite awhile to convince the hierarchy there to allow him to come to Juneau.

And we had to reassure them that we were not wanting him to come to lobby or convince in any way, it's what I called the ‑‑ just the facts, ma'am, just the facts. The sort of Dragnet approach.

And David came and it was very powerful testimony. Even though generally Alaskans don't really care how they do it Outside, when you get somebody from a foundation that has spent $70 million on something, and they figured out what works and what doesn't, and they are explaining this to the legislature, they pay attention.

And so now, in addition to our funds and the normal AHFC funds, the legislature has now committed several million dollars a year in additional funding to put this supported housing package together. And now, this current year, whereas before, remember, we could hardly give away SNHG funding, this last year we had 16 applications for the money, far more demand than we could ever fund, because now the housers are starting to understand how to put these packages together in a way that works.

Section 4: Now, of course, one of our most challenging populations to house are people who are long‑term chronic alcoholics. This is your classic sort of street person. Chronic homelessness, chronic alcohol addiction, you know, many of those folks have been through treatment eight, nine, ten times, and ‑‑ and we don't know why we aren't able to help them get into recovery, but the fact is, they've been through every recovery program that we've developed and it just isn't working.

And they are at great personal risk.
And what few people understand is they are also extremely expensive because they intersect the non‑mental health service system in many, many ways. For example, they get all their healthcare at the ER. And they are in the ER pretty often.

If they are found on the street and they are ‑‑ you know, have medical needs, after detox, they often end up in the ER. If they fall down or pass out in a doorway, the fire department and the police department have to respond as if it might be a crime.

I mean, if you see somebody lying in a doorway and you call 911, they don't know that it's somebody who is passed out from alcohol, it could be a murder, and so the police respond, the fire department responds, you know, it's a tremendous cost.

In fact, there was a famous article in the New York ‑‑ New Yorker called Million‑Dollar Murray. And they followed one chronic street inebriate over 10 years, and it cost the public system a million dollars for him to be a public inebriate. And so there's this huge cost.

But now once you start talking about housing people, the gold standard in substance abuse treatment for many, many years has been abstinence. Abstinence is the gold standard. And there has been a lot of controversy around the concept of harm reduction.

You know, if we can't get somebody sober, can we at least get them safe, can we get them housed, can we get them off the streets, and out of these services, and ‑‑ and hopefully, at least, reduce or manage their drinking, if we can't get them into sobriety.

Well, that's pretty controversial. A lot of people feel like, well, you're just enabling these folks. You know, if they ‑‑ it goes all the way back to societal attitudes and biases around alcoholism, and seeing it as a choice as opposed to a disease. And so when we started looking at these beneficiaries, and of course, for us, we're very concerned because, you know, they are at great risk, and in fact, they are often dying on the street.

And again, we did the same thing, we started looking around to, well, who has ‑‑ you know, who has approached this. And ‑‑ and this is a movement that's now sweeping through the country, it's called Housing First, and ‑‑ and the concept is what we used to do is tell people that if you want housing, first you have to get sober.

And as soon as you get sober, we'll give you housing. Didn't work for this population. And so then they decided, well, why don't we flip this. Why don't we give them housing first, and then see if we can't manage some of these other problems.

And it turns out that's phenomenally successful. In fact, what doesn't get a lot of press attention is that some major metropolitan areas in this country have dramatically reduced their street population by providing housing first. In some places, 30 to 40 percent reductions.

And we're talking New York City, Los Angeles, Denver. You know, this is ‑‑ this is definitely a proven technology. But, getting the first project to happen in Alaska presented some real challenges.

Section 5: And so one of the things, again, that the Trust was able to do is we gathered together some politicians, some housers, AHFC, and we found a project, again, in Seattle called 1811 East Lake that had developed a Housing First project, and had rigorously evaluated the results, and ‑‑ and had really turned the political tide in Seattle around on this concept. And we contacted them and they were gracious enough to host a team from Alaska to go down and actually look at how that operated.

And what was great about that is that what we were able to do is, for example, there was an assemblyman from Anchorage, Dan Coffey, and he was quite the skeptic about this approach, and he was able to talk to peers on the Seattle Assembly who were politically pretty similar to his views and able to have them explain to him how they hadn't given this thing much chance either when it started, and by gosh, now that they see what the results are, this thing is good.

The police chief went, and yeah, it's great to listen to the social workers tell you what a great program this is, but he wanted to talk to the cops. And what he found out from the police in Seattle is, hey, we used to be rousting these guys all the time, we used to be ‑‑ you know, petty street crime, we used to deal with them all the time, we would get these calls about them being in doorways, we knew them all. We knew them all. And now, we don't see these guys at all anymore. Because they are housed. So from a police standpoint, this is awesome.

And so by bringing that back, we were able to get the first major Housing First project finally approved by Planning and Zoning in Anchorage over considerable neighborhood opposition. And we're confident that when that project gets implemented, that we're going to make good on our commitments to that community, that neighborhood, that this is going to improve their situation, not make it worse.

BILL SCHNEIDER: What are the additional services you have to provide in order to make that work?
JEFF JESSEE: Well, for example, you need to provide more on‑site medical care. So many of these people are medically compromised, they've got lots of health issues. But you're able now to do it as part of a more cost‑effective process of providing medical care than waiting until they are in crisis and they are in the ER and they have an expensive hospitalization.

So that's one area.
The other is enforcing some really basic rules. You know, even if you're going to keep drinking, you can't drink in the public spaces. You know, you can't loiter around the building. You know, you can't bother the neighbors.

And they are held to these conduct requirements, and people do get evicted, but a lot fewer than you would think, once they are able to actually access housing.

And of course, there's ‑‑ you know, food preparation happens, and they are, you know, having access to meals and, you know, so it's a very cost‑effective, as well as obviously humane way of trying to help people that are really at the very bottom and the most severely impaired because of their addiction.
So that's the housing area.

Section 6: Another area, and it's interesting how this came about, years ago Alaska had had an individualized system of care for adolescents with mental health issues, it was called the Alaska Youth Initiative. And for various reasons, it ended up being de‑funded, and what started to happen in about the mid '90s, about when the Trust was created, is more and more Alaska kids were being sent Outside for residential psychiatric treatment.

And the main reason for that was that we had virtually no continuum of care in place. Once you got to the point where you couldn't stay at home, there really was not much else for you to go to until you got to Utah or Texas. And so more and more of these kids started to get placed outside.

And by 2004, this problem had gotten so big that we had over 430 kids in these out‑of‑state facilities, at a cost of over $40 million a year. And the trend was looking like it would continue unabated into the future because there was no effort to provide any kind of alternative service.

And Governor Murkowski came into office and appointed Joel Gilbertson as commissioner, and they were concerned about this, both from a budgetary standpoint and from a quality of care standpoint. And the Governor asked us to come to a meeting in the Governor's conference room with the chief of staff, and asked us if we would work with the administration to address this issue.

And so the Bring the Kids Home Initiative was created out of that. And so we used our formula for success, which was to start pulling together, once again, you know, pulling together the stakeholders, the providers, the families, the state bureaucrats from the different agencies, you know, and getting them all together and saying, all right, what would we have to create in Alaska in order to serve these kids.

And this is a fascinating initiative because if you were starting a Bring the Kids Home or ‑‑ if you were starting a children's mental health system from scratch, well, where would you start? Well, the first thing you'd want to do is give as much support to the natural family as you could.

And then if that didn't work, you would then try to find a out‑of‑home placement that was at least in that community so that you could continue to work with the family and eventually reunify the family. And if that didn't work, you would then move to a regional hub and possibly to Anchorage, and then only as a very last resort would you end up in Texas or Utah.

Well, the problem with that is that if we approached the legislature and said, all right, here's the deal, if you invest $5 million, say, just arbitrary number, in these early intervention services for families, in eight years or so, trust us, these out‑of‑state numbers are going to come down, that is not getting funded because the legislature doesn't have that long‑term horizon for a return on investment.

And so what we needed to do was to, in the short run, drive down the number of kids that were out of state in order to demonstrate that we knew how to develop an effective continuum of care.

Now, one thing that was interesting that the system was so out of control that if I thought my daughter needed to leave the house because her behavior is just unacceptable, and I came to you, my psychologist or psychiatrist and you agreed that she should be placed in a facility in Utah, then we would put her on a plane and take her to Utah and drop her off.

Now, at this point, the state has no idea that this is happening. This is totally a private enterprise. Now, at the end of 30 days in Utah, my income is no longer deemed to her and she becomes Medicaid eligible, retroactive to the date she got there, okay, now what does that mean? Well, that means the first time the state finds out that my daughter is in a facility in Utah is when they get a bill for the first 30 days.

Well, this isn't working for them, and so they then say, well, how do we know your daughter needed to go there? And so they send somebody to check it out. Well, now, this facility's had 30 days to develop a record establishing‑wise ‑‑ surprise, surprise ‑‑ what my daughter needs happens to be exactly what they offer at a very high cost. And so the state now is on the hook with no way of getting back out of this because this is a totally unmonitored, unregulated process.

So the very first year, the only thing we did was tell everyone we were going to start watching this. And the numbers went down. Just by telling them that now we were going to be reviewing every one of these out‑of‑state placements. And if we didn't tell the state we were doing this ahead of time, then they were going to refuse payment.

And it's the same phenomenon ‑‑ and actually, this surprised us. I mean, we didn't really even expect to have this result, but it's very similar to what happens on a freeway. If people drive the freeway and they never see a police car, the average speed goes up. As soon as you put a police car on the road, you can just park it there, you don't have to give anybody a ticket, and the average speed comes down.

Well, that's exactly what started to happen is now more and more people started to say, well, now, wait a minute, you know, the state's starting to watch this, so that was the first step, was at least to start to bend this curve a little bit, this increase.

Section 7: And then we started looking at, all right, we ‑‑ we want to start down here in the family and early intervention and prevention, but we've got all these kids out of state, we've got to start developing group homes, foster homes, you know, that can actually reduce those out‑of‑state placements. And for several years, we started investing in this.

And again, this is too big for the Trust. The ‑‑ the ‑‑ what we're spending our money on is the initiative infrastructure, you know, paying for the work group to meet, you know, bringing up people who have experience in the field, and educating folks on what the options are, gathering data about who these kids are and what their needs are and what we need to do. Not unlike the Harborview project, in many ways.

And what we said to the legislature is, look, you don't necessarily have to spend more money to do this, but you need to start taking the $40 million that you're spending out of state and start investing it in state in these services, so that we can have these kids served here, and by the way, not only serve them better, closer to home, in a more culturally relevant way, but create jobs in Alaska instead of creating jobs in Texas and Utah and Colorado,

and in the end, you may or may not end up spending any more money, but you will have a more effective system of care in the state. This probably starts to sound familiar. It's helping the state understand how to get more bang for their buck by providing better services and managing this type of an initiative.

So we started with over 430 kids out of state. We have just gone below a hundred. And so we're down to about 95 kids. Now, in the end, there will probably be a few that present such complex or challenging behaviors that there will probably always need to have some resource for out‑of‑state specialized care, but we think we can get that to a fairly irreducible minimum.

And along the way, as we're driving down the big curve, we're also encouraging the legislature to invest in these earlier intervention strategies so that we don't even get to the point where kids need out‑of‑home services.

Section 8: BILL SCHNEIDER: So you were actually funding some of this transition or just providing the information and the statistics?
JEFF JESSEE: We funded some of the actual implementation, and a lot of times what we would do is let me just give you an example.

Medicaid is still a main funder of these types of services. The problem is, Medicaid doesn't pay for certain things that may not be very expensive, but could be critical to the success of a ‑‑ of a plan, and let me give you an example.

You've got a kid who is just struggling in school, and that's part of the whole dynamic at work that's creating mental health issues, behavior issues, all of that. And so you say, well, we've got to ‑‑ you know, we've got to find a way for this kid to be successful in school, or we're going to be fighting this for a long time. It deals with the self‑esteem, self‑confidence, and all of that.

Well, what would you do. Well, boy, we really need to get him a tutor. I mean, if he had somebody that would sit down with him, you know, an hour or two a day, and help him get his homework done, you know, and ‑‑ and be successful in school, well, that would translate into lots of good things.

Well, nobody pays for that. Nobody pays for a tutor. And so we created a pool of individualized services that agencies could apply and get a small grant to provide these little extras that can make the difference for some of these kids. And tutoring is one example.

Buying hockey gear and signing a kid up for hockey so that now they've got something to work towards, you know, they've got something positive going on in their life. What we did on that is we split it with the legislature. We said, we're not sure how this is going to work, so tell you what, we'll split it with you. And let's see what we get as results as we go down the road. So again, we provided startup funding.

Give you an example. You're going to start a group home. Okay. We need ‑‑ we needed a bunch of them, and agencies came and said, well, we can start a group home, and it's sustainable, but here's our problem. You can't open a group home for six kids and bring the staff in on the 1st of January along with six kids and say, here we are, you know, we're open for business, day one.

First you've got to bring the staff on and you've got to train the staff. Then you've got to bring maybe one or two kids in and get that settled down, and then you can bring another couple of kids in, and it probably takes you six months from startup to full utilization. But now the funding is driven by the kids that are in the home.

So how does the agency pay for this startup cost? Now, once they get to six months and they are ‑‑ they are fully operational, they are fine, they are sustainable, everything's good, because the business model works.
Well, that's where the Trust comes in. We provide that startup funding.

So now, agencies that before couldn't help the state solve this problem, because they didn't see how they were going to be able to ramp up this capacity, now have access to a funding source that allows them to get the staff hired, you know, get the staff trained, gradually bring these kids in, now this works. And so that's been our role through that.

And it's been very powerful in terms of the legislature. You know, as we've gone in every year and shown them how their out‑of‑state costs are coming down, they are reinvesting in the state, and we have turned this curve. And ‑‑ and it's one of the most successful ‑‑ you know, people say government can't do things. I mean, this is one of the most successful efforts that I've ever seen out of state government. I mean, this is a huge transformation.

Section 9: And now, as we sort of finish the initiative, you know, the idea is to finish things, not just perpetually work on them. Now we're looking at what can we do to solidify this new system of care so that when we stop working it, the problem doesn't just start back up again. And ‑‑ and the key to that are these early intervention services.

And a key to that is partnering with the education system, because by and large, families with these issues are not self‑reporters. You know, they ‑‑ these kids don't spring from the head of Zeus. You know, very often they are coming from very challenging family circumstances. There may be substance abuse in the family, maybe mental health issues, often poverty, broken families, you know, dysfunctional families, and if we can identify those situations earlier, then we can work with the whole family.

In fact, one of the failures of the previous system is that by the time the kid left the home, the system responded as if the whole problem was the kid, and if we just fix this kid, everything would be good. Well, that never worked because you've ‑‑ you've fixed the kid, whatever you think that means, and you put them right back into the environment that they came from that had often a role in creating the problem to start with, and they are not going to be successful.

And so now we're working with education trying to get them to help because they are probably our best early warning system. You know, these families are more likely to be identified early on because, you know, I did a lot of volunteering in my kids classrooms, and I'm no mental health professional, and I can tell you who the kids were in that classroom that were going to have trouble.

I mean, it's not rocket science. But the problem is our old system waited and waited and waited until these kids got worse and worse and worse, and now they are getting expelled and suspended and things are really bad, and then they show up in the system.

And ‑‑ and we're trying to solve a problem that was years in the making. And so that's the Bring the Kids Home Initiative. So these are the ways that we continue to work to improve the mental health system over time.

BILL SCHNEIDER: Well, that's pretty impressive.
JEFF JESSEE: It's ‑‑ I think the trustees have just done an incredible job of managing these resources in a way that, you know, has truly been transforming in so many of our systems of care.

Section 10: BILL SCHNEIDER: What about the critics? Who are the critics and what are their claims?
JEFF JESSEE: Well, we do get pushed back from the legislature, and usually it's in the form of, A, you should be doing more to support our core expenses. So rather than using all your money to do these fancy things, you should be contributing more for the core operating parts of the program. So that's one that you hear.

The other criticism that we get a fair amount from the legislature is, look, we can't afford this much success. You know, you guys go out there and you pilot these projects, and you sift out the ones that work from the ones that don't, and then you fund the ones that work for a certain number of years, and then you come in and expect us, the legislature, to pick up the costs of those programs.

And it's getting too expensive. Because you're bringing too many successful projects to us.
And it's hard for them to actually articulate it this way, but it's like when you demonstrate that level of success and you bring in advocates who can use that information to support the need for funding, it's very difficult for us to say no.

And as our income grew, and we went from $15 million a year to $25 million a year, and got better at what we were doing, the problem for us and the legislature was the request for them to take over funding in every year was getting to be substantial.

BILL SCHNEIDER: So it really is a pretty uneasy relationship. It's been an effective relationship, but an uneasy relationship with the state government?
JEFF JESSEE: I think that's an excellent way to frame it. You're exactly right. They ‑‑ they love us when it's doing something they feel they needed to get done, and it frustrates them when we're asking them to do things that they are having trouble finding the money for.

BILL SCHNEIDER: And that probably will get more exacerbated in the future.
JEFF JESSEE: I think so, although, you know, a couple of things about this. One is it turns out that we generally have just the right amount of income.

And I'd love to be able to say that back when we were figuring out the land and how much cash we were going to get that we had anticipated how this would work, how this relationship with the legislature would develop, and all of that, and that we carefully developed, you know, a plan that would fit right where it needed to be. We just lucked out. Because here's how it works.

Again, we're 25 million on a $300 million mental health program, right? If we had less than we have, like, say, 5 million a year, we wouldn't get much done. I mean, you know, by the time you have your operating costs to run the ‑‑ the shop, you're not left with much resource to get much done.

If we had 50 million a year or 60 million or a hundred million, the legislature would not be able to resist forcing us to devote a huge amount of that resource into the core services for the state. And they'd be right to do so. You know, because that ‑‑ the Trust is here to fund the program.

And so by luck, frankly, well, and the wisdom of the trustees and how they set up the payout system, we found the sweet spot, you know, where it's ‑‑ it's enough to get stuff done, but it's not so much that the legislature is willing to reopen the Alaska Mental Health Lands Trust issue in order to get at, what, $10 million? 15 million? How much can they steal from us?

Not enough to make a big dent in the budget, but enough to generate litigation and a lot of controversy and to what end?
But those are ‑‑ that will always be an uneasy alliance.
BILL SCHNEIDER: Yeah.

Section 11: BILL SCHNEIDER: If ‑‑ if you were a parent of a beneficiary and your ‑‑ the beneficiary was age over 30 or so, and had been involved with the Trust over the period of the Trust's history, what might some of your comments be? Would you ‑‑ how would you be evaluating the Trust?
JEFF JESSEE: Well, I think that ‑‑ that you would want to say, well, what sort of trajectory was my child and our family on?

You know, where did we see things going in dealing with our child's disability, and then where are we today. And is that better than what we thought was going to be, and ‑‑ and if it is, did the Trust have any role to play in making that happen.

BILL SCHNEIDER: Do ‑‑ do beneficiaries and their ‑‑ and their sponsors make a separation between the Trust and the state programs?
JEFF JESSEE: Oh, very definitely.
BILL SCHNEIDER: They do?
JEFF JESSEE: They do.

And our ‑‑ the main reason that ‑‑ that they do is because the way our system is set up, again, we have only 7 trustees, and a staff of 14, and we have all of these varied beneficiary groups with their different needs and priorities, and the way that we sift out from that what needs to be done is that we have these four planning and advocacy boards that we partner with.

The Mental Health Board, the Advisory Board on Alcohol and Drug Abuse, the Commission on Aging, and the Governor's Council on Disabilities and Special Education. And they are, in essence, our interface with the beneficiaries and their families because those organizations have as members family members, consumers, members of the public, and ‑‑ and they are the ones that are closer to the ground and ‑‑ and they bring recommendations to us, or to the trustees for what we should do, and what areas we should work in.

And so to the extent that ‑‑ that those consumers or families understand how systemic initiatives get created by coming through those boards, then they are pretty clear that the Trust is trying to be responsive to what those priorities are.

Section 12: BILL SCHNEIDER: Karen?
KAREN BREWSTER: I was going to say, what are some of the challenges? You've talked about all these successes, have there been times where you've had failures and challenges?
JEFF JESSEE: Well, I think there are a lot of areas where we have not been able to achieve as much as we would like. One area is, again, we're still obviously working it, but disability justice.

42 percent of all inmates in the Department of Corrections are Trust beneficiaries. That's huge. And although the therapeutic courts have been effective, we have a program called Bridge Home that helps take beneficiaries coming out of corrections and transitioning them into the community, and it's been very effective.

We have not been able to go to scale with these projects. And so the ones we have, have been proven to be effective, but we haven't been able to go to scale, and primarily that's because the order of magnitude of what it would take to go to scale is way beyond our means. And until we can convince the legislature that that type of investment is warranted, we won't get there.

Now, this next year may present an opportunity because the legislature is going to run up hard and fast on what it costs to build and operate a large prison. They will be bringing a new prison on line, and they are going to be looking at many, many, many millions of dollars to house people in corrections.

We believe we can, with our beneficiaries, we can do a better and cheaper in the community. But the legislature has to cross the Rubicon in terms of their thinking;

and it's one thing to convince them on the scale of Bring the Kids Home where there's $40 million or Harborview where there's 5 or 6 million, it's another thing to start getting them moving on something that's hundreds of millions. And so I think that's one area that ‑‑ that we haven't been able to go as far as we would like.

Section 13: KAREN BREWSTER: The therapeutic courts you just mentioned I wanted to ask you about, how is it that some members of the population end up in therapeutic courts and some still end up in the mainstream criminal justice system?
JEFF JESSEE: Generally, when they are arrested and they end up in jail, the Department of Corrections knows them, because they've seen them before, and they do a screening and they start trying to identify those beneficiaries that they think, if they were to go through the Mental Health Court, that they would benefit from this approach.

And then they provide that information to the rest of the team because the, you know, Public Defender and the District Attorney, you know, there has to be agreement that this is somebody that should be offered this alternative to normal prosecution and incarceration. And not ‑‑ you know, none of these programs are perfect. Not everyone is successful, but many, many are.

KAREN BREWSTER: And the therapeutic court is only for misdemeanors; felony cases don't usually get recommended there?
JEFF JESSEE: For our beneficiaries, I believe there is a felony DUI court, which is not one of ours, so to speak, but yes, all of our therapeutic courts are ‑‑ are misdemeanors. If you're talking serious harmful behavior, then that's going to be handled differently.

Section 14: BILL SCHNEIDER: All right. Well, Jeff, thank you so much for taking the early flight up and ‑‑
JEFF JESSEE: My pleasure.
BILL SCHNEIDER: ‑‑ spending the time with us. I think you've given us a really thorough, interesting picture in terms of not only the mental health delivery system, but also how you've effectively worked with the legislature that might serve as a model for other groups, too.

JEFF JESSEE: Well, that's one of the things, I'm on the board of Philanthropy Northwest, which is a philanthropy affinity group for the Pacific Northwest. And one of the ‑‑ one of the things that I've been working with other foundations on is encouraging more engagement with government.

Traditionally, foundations have tended to want to give time‑limited grants to get something going, and then the funding goes away, even if it proves very effective, but the heavy lifter and the sustainable funding has to come from government. And if you don't engage up front, there's very little likelihood that you're going to get much support when your money goes away.

And ‑‑ and a lot of foundations are very gun‑shy about directly engaging government, and one of the things I'm trying to promote is that, no, you should do more of that, more engagement, and more partnering because in the end, you know, legislators want good public policy, they want cost effective and efficient services, and by linking the venture capital of foundations and charitable organizations, it's a powerful partnership.

KAREN BREWSTER: Has the model of the Mental Health Trust Authority been used in other places? It was sort of a first‑time thing when it was established here, wasn't it?
JEFF JESSEE: Well, nothing exactly like it, but there are, for example, in some areas now housing trusts that in many ways operate somewhat like the Mental Health Trust.

You know, so I think there are some similar type of organizations, but I think the Mental Health Trust is certainly unique, certainly in the ‑‑ in the sense of combining a land base with financial assets, being a state corporation that has the freedom to act like a private foundation, you're not going to find many of those. And we wouldn't have had this one if they hadn't stolen the land.