SmartTranscript of House Healthcare - 2025-1-29 - 10:50 AM

[Chair Alyssa Black ]: We coming up here a little bit. We had a small spill. We're gonna go to Chris Allen, who is our director of suicide prevention in the state, and he's with us on on Zoom. [Witness Christopher Allen ]: Good morning, everybody. Can everybody hear me okay? [Chair Alyssa Black ]: Yep. We can. [Witness Christopher Allen ]: Awesome. Thank you. And, Stephanie, do you mind just sharing the slides when you get a second? She's in the room. [Chair Alyssa Black ]: Oh, Oh, okay. Oh, I'm sorry. I wasn't even yeah. I see that Nick Nichols is is on with us. He does. So Nick Hi. And company. Company. So you're in person with us? I think so. Yeah. If you wanna sit up here, that that would be fine. [Speaker 2 ]: I'll put chairs to myself. [Stephanie Bloch ]: Okay. If I only made it, Stephanie, I am ready. I'm not. I'm also sharing the slides, which is why Chris needs me right this second. Alright. Great. Do we wanna wait to okay. [Chair Alyssa Black ]: We can get the slides up. [Stephanie Bloch ]: And, Chris, if you wanna [Chair Alyssa Black ]: go ahead, and I'm assuming you and and Nick have worked out between the two of you. [Witness Christopher Allen ]: Absolutely. Yeah. So good morning, everybody. Thank you, madam chair and committee members, for asking us to present on suicide prevention in Vermont. I'm I'm, coming to you remotely as I, I love to share things, but I don't think anyone would appreciate the cold that I'm I'm I have right now. So I'll keep that to [Speaker 4 ]: my side. So much for that. [Witness Christopher Allen ]: So, good morning, everybody. Chris Allen. I'm the director of suicide prevention, for the state of Vermont. I work for the Department of Mental Health, and I'm also a licensed independent clinical social worker. And I'm joined here by a few colleagues. So, Stephanie, would you like to introduce yourself? [Stephanie Bloch ]: Yeah. Thanks, Chris. So my name is Stephanie Bloch. I use she with pronouns. I, work at the Department of Health, so I'll be doing the second half of the presentation, and [Chair Alyssa Black ]: I'm the Ingrid Prevention program director. [Witness Christopher Allen ]: Awesome. Very well. Well, thank you, everybody. So during this presentation, we will provide a brief overview of available resources. Kinda give a an overview of, suicide prevention, including, some various approaches, some key highlights of suicide prevention in Vermont, take a brief look at the strategic plan that was submitted in July of this this past year. Also give some information about the Department of Health grants and look at some data, some some successes, and ways to stay involved, following today's presentation. Stephanie, do you mind just going to the next slide? Thank you. Yeah. So here, I just wanted to kinda set the ground, and share a few available resources, and really just deliver a message, that you are not alone. So this presentation contains references to themes of death or dying, mental health, suicide, firearms, and the prevention work we are doing here in Vermont. We encourage people to take steps needed for your emotional safety and health. This may include stepping away from this presentation. And please do know that supports and resources are available twenty four seven. There's a few of those, supports listed here, such as nine eight eight, the suicide and crisis lifeline, and you'll hear more about nine eight eight, when DMH gives, testimony this afternoon. The Trevor Project, which is, for LGBTQ, youth and adults, and then the Pathways support line, which is, a peer support model that's available twenty four seven as well via calling or texting. Next slide. Thank you. So really just trying to, part of, suicide prevention is making sure that we're using common language, not everybody is familiar with. And, this language has changed over the past, few decades here. Many people aren't aware of these changes and how we talk about suicide, and also report on suicide, but know that words have the power to heal, and they also have the power to do harm. And that can be unintentional or not, and can bring out stigma and our attitudes on how we feel about suicide. So on the left side here, you'll see some suggested language of what to say instead of what is on the right hand side. So just so folks are aware, a good good litmus test for this is the words commit or committed may imply that an act is criminal or may be looked at as a mortal sin in many religions. So if you replace, suicide, with cancer, you would not say, committed cancer or or died by cancer or attempted cancer. So if you substitute suicide or cancer for suicide in those instances, it's a good way to remind ourselves of what would be appropriate language, in these situations. We also would want to, just focus on providing factual and direct language that is judgment free of the person or the situation. [Chair Alyssa Black ]: Can I interject here real quick just so I can keep up on appropriate language? Do we no longer use suicidal ideation? [Witness Christopher Allen ]: That is a term that we do still use, although it's primarily used in academia and not really within, like, the lay, person's, language. [Chair Alyssa Black ]: Okay. Thank you. [Witness Christopher Allen ]: Yeah. You're welcome. And there's a there's a source, linked here, on the slides that you all have that, goes into far more detail about language, and there are, there's a lot more additional information there, if you're curious about finding out more. Next slide, please. So when we think about, suicide prevention, there's a few different approaches, and it is both a mental health and public health issue. And so that's why we have both folks from the Department of Mental Health and the Department of Health as, we wanted to share about programming, that both of us are, taking on and supporting. So what is public health? It is the science of protecting and improving the health of entire populations and their communities. And why this matters for, suicide prevention, is that it takes a population approach, and primary prevention are critical to suicide prevention. And we also know that people that are at risk often do not seek help, didn't ask for help, or didn't get the help that they needed. So we know here in Vermont that only thirty two percent of Vermonters who died by suicide were engaged in mental health treatment at the time of their death, which is why we wanna combine a mental health approach with a public health approach so that we can expand suicide prevention initiatives beyond mental health treatment, into communities, health care, and the general public. And I just wanted to point out, this quote at the bottom of the slide, that refers to, the public health campaign, that the Department of Health and the Department of Mental Health have been working on, over the past few years called Facing Suicide BT. And it is, it is a website that you can also access that has ways to get involved and other available resources. It also has videos about real Vermonters stare sharing their stories of recovery and their experiences with suicide loss. And so it's important to keep in mind that all Vermonters have a role in facing suicide. Next slide, Stephanie. I should also add before, going too far in, that I I can't see if people have hands up or have questions, so, feel free to interject while I'm going through the slides. And I can pause or move back a slide or two. [Chair Alyssa Black ]: I'll let you know if someone has a question. Thanks, Chris, for lagging that for me. [Witness Christopher Allen ]: Yeah. Perfect. Thank you. So in addition to, a public health approach, we wanna also think about, suicide prevention, comprehensively. So this is also including across the lifespan, so that we're not just focusing on certain populations, but also focusing on all ages as well. So effective suicide prevention is comprehensive, and it requires a combination of efforts that work together to address different aspects of the problem. Hence, the various puzzle pieces here, Each of them interact with each other and play off of each other, in order to build an effective, approach, to suicide prevention. So there's there's a complex set of strategies as part of, each of these, puzzle pieces, which requires lots of partners. And it's also a way that we can that there's numerous ways to have an impact on suicide prevention and make sure that people have the support when they need it and where they need it. There are many evidence based practices as well that are part of each of these, puzzle pieces as well. And so I just wanted to highlight a few of those buckets. As we build out a statewide program, we wanna make sure that we're addressing all of these areas and and that none of them are left behind or forgotten about. So in a mental health treatment bucket would be effective care and treatment, responding to crises and care transitions. And more broadly, we would want to also identify and assist, people, that are experiencing suicidal ideation and also increase help seeking for those that, are struggling in in crisis. There's also specific strategies for lethal means, and reducing access to lethal means. As we know, when people have access to lethal means, they are at increased risk for dying by suicide in a time of crisis. We also wanna focus on building protective factors such as life skills and, connectedness because we know when people feel more connected to those around them and people in the community, They feel like they matter, and, and they're less likely, to attempt or die by suicide. And then we also know that people who have been impacted by suicide loss are at increased risk of suicide, which requires us to maintain a focus on postvention. And before I move into the other slides that I have, I wanted to make sure that there's, if there's any lingering questions about kind of suicide prevention, one zero one or, an overview of it. [Chair Alyssa Black ]: Any questions? Oh, Mari? Yes. [Member Mari Cordes ]: I'm looking at the facing suicide program on your website, and I noticed that it was, funded with a CDC grant. Is that in jeopardy? That or so you already have them running? I'm gonna cover that [Stephanie Bloch ]: on the second half around the grants that the health department has that is part of that funding with us that I'm initiating suicide. [Chair Alyssa Black ]: Sorry to cut you off, Chris. [Speaker 4 ]: No. No. No. [Stephanie Bloch ]: No. It's [Witness Christopher Allen ]: it's a great question. Yeah. And one I think that we're all holding on to the edge of our seats for. So thank you. Next slide. So here on this slide, I just wanted to provide a, timeline of suicide prevention efforts in Vermont. This is by no means a comprehensive timeline. Just wanting to list a a few major highlights, here. So, back in two thousand and eight, the statewide coalition, was founded and began meeting, throughout the year and continues to meet, three times a year, to this day. In twenty sixteen, Vermont adopted the zero suicide framework, and that started with three DAs, designated agencies or community mental health agencies, adopting that framework and beginning that implementation of the zero suicide framework. We have in twenty twenty two, we extend we expanded collaboration, and Stephanie will provide more details about what that looked like. But in brief, we that's when we received the the CDC comprehensive suicide prevention grant and SAMHSA's GLS, Garrett Lee Smith, youth prevent youth suicide prevention grant. At that at that time too, in spring of twenty twenty two, we also signed on to the governor's challenge, which I'll share more details about as well. In June twenty twenty two, the director of suicide prevention position was created, which is the role that I'm currently in. In July twenty twenty two, nine eight eight was implemented, and that was the the nationwide three digit code to call for suicide in crisis. In June twenty twenty three, act fifty six was passed, which required the development of the state strategic plan and model protocols. In January twenty twenty four, the model school protocol, was submitted. In July twenty twenty four, the state strategic plan, the first ever state strategic plan, was submitted along with, model health care facilities protocols. And ongoing work is the implementation of that strategic plan and the model protocols, that have been submitted over the past year. Any questions about the timeline here? [Chair Alyssa Black ]: Okay. I don't think so. Awesome. [Witness Christopher Allen ]: Moving right along to our partners. They'll just share really quickly that we work with many partners that support this work, including the state legislature and that and also federal partners such as SAMHSA, the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention. And then we also work with community and local partners as well, such such as the Center for Health and Learning, Vermont Care Partners, and Vermont Program for Quality and Health Care. And each of these partners play a a part in having a successful statewide program and contribute to the comprehensive approach that I mentioned earlier. [Chair Alyssa Black ]: I think I think Leslie has a question. Just Yeah. Thanks so much, Chris. It's been really interesting to follow this along over these years. And you said that the model school protocol was submitted. Can you tell me who it was submitted to and then what happens? [Witness Christopher Allen ]: Yeah. Absolutely. So that model school protocol was submitted to the house health care committee. So the committee that committee and the senate health and welfare committee back in January twenty twenty four. And that, we can follow-up if if you don't have that, on hand as well. But that protocol that was, that was submitted has now been incorporated into the Center for Health and Learning has a, UMATTER for Schools, training, that's, geared for, school administrators, teachers, and [Speaker 4 ]: and [Witness Christopher Allen ]: counselors. And so that protocol has been incorporated into that training. So anyone that is, participating and accessing that training now gets trained on that model school protocol that was submitted. [Chair Alyssa Black ]: Thank you. Yeah. The the link in your presentation is live, so we're good. Thank you. Very well. Mar I think Marri has another question. [Member Mari Cordes ]: Looking at that model school document that, you shared, I noticed that we did some work in the legislature around eating disorders. Will you be talking today about that program and your successes and barriers with the eating disorder component? [Witness Christopher Allen ]: I won't be addressing that within this presentation, although, doctor Haley McGowan, which is the children's medical director at DMH, has been spearheading that work and, you know, I'm sure would be happy to provide testimony on on that or follow-up with you. [Chair Alyssa Black ]: Great. Thank you. We'll look into that. Yep. Thanks, Chris. [Witness Christopher Allen ]: Yeah. You're welcome. Moving right along here. Just wanting to share about the governor's challenge, which, was signed governor governor Scott and the adjutant general, Gregory Knight, signed on to the governor's challenge in the spring of twenty twenty two. And the objective of this is to form an interagency military and civilian team of state leaders and policymakers to develop and implement a strategic action plan to prevent and reduce suicide amongst service members, veterans, and their families. There are three focus area focus areas, and each of these focus areas has a distinct group that that works on either implementing implementing the the specific objective that that focus area has. So identifying the population and screening for suicide risk or promoting connectedness and improving care transitions. And then the third one is increasing lethal means safety and safety planning. For the first focus area, we have, created an ask the question toolkit for emergency departments. It's a quick access guide that folks can have available to them as they're working with individuals that are experiencing suicidal ideations. And the, second focus area, which is on has looked at connectedness and improving care transitions, we will be launching, in the very, very near future, a resource map, of Vermont based clinicians that have shared interest and specialize in working with service members, veterans, and their families, which is what the governor's challenge focuses on as they're at disproportionate risk for suicide. [Chair Alyssa Black ]: I I just if I can interject just because this is such an important piece, and I just wanna highlight it. I don't know if you or Nick, if he wants to jump in. If you know offhand what sort of the national suicide rate is among veterans, service members, and where Vermont has traditionally fallen in relation to that? And and perhaps how it's the incidence is much higher than in the general population. [Witness Christopher Allen ]: Yeah. Absolutely. Thanks for, bringing that up, and that's a great question. So, back in January twenty twenty three, we had the most recent reporting that we had and data available was that the US rate per a hundred thousand was around twenty for suicide deaths amongst veterans. And then in Vermont, it was eighty three point three. So in Vermont, we know that veteran service members and their families are at much, much higher risk, for suicide and attempting suicide. [Chair Alyssa Black ]: I I don't mean great. I mean, thank you for highlighting that. [Witness Christopher Allen ]: Of course. [Chair Alyssa Black ]: Chris, I [Stephanie Bloch ]: have updated numbers when I speak to the data later. Great. [Witness Christopher Allen ]: And the third focus area is is providing a grand rounds presentation to emergency departments. And we also share the ask the question toolkit in collaboration with the first priority area. During this grand rounds presentation, there's a a focus on the Stanley Brown safety plan, and we also go through counseling on access to lethal means, which is a a training that's available. That's an it's an evidence based practice as well. And we do this Grand Rounds presentation in collaboration with the National Guard, the veteran affairs office, and, the Department of Health and, the Department of Mental Health as well. Moving on to the next slide here. Just wanting to share a little bit of information about the strategic plan, which was submitted in July of last year. So the Vermont State strategic plan for suicide prevention aligns with the strategic directions that were outlined in the twenty twenty four national strategy for suicide prevention. That national strategy was, submitted in, in the winter of twenty twenty four, and had been updated, from, twenty twenty from twenty twelve. So those four strategic directions are community based suicide prevention, treatment and crisis services, data, quality improvement, and research, which is actually we diverged a little from the national strategy for the third strategic direction. As at the national strategy, it says surveillance, quality improvement, and research. And we heard from advocates within the state of Vermont that, surveillance was not an acceptable term to use there. And so and then the fourth strategic direction is health equity. And just because we're running up against time here a little bit, I will just point out the, that the strategic plan is can be accessed accessed, via link at the bottom of that of this slide, and also the twenty twenty four, national strategy is accessible there as well. Moving on to the next slide. Just wanting to, provide an update, since the strategic plan was submitted in July twenty twenty four, that I we're turning our plans into action. So I wanted to highlight a few recent achievements in suicide prevention work here in Vermont. So here are a few, updates. We've increased awareness in the in the community, by expanding public education and outreach initiatives, just making people aware that there is a state strategic plan as there wasn't one previously. We've established leadership and collaboration by creating a executive committee to oversee the strategic direct directions, and we've also launched implementation teams that are assigned to the specific, strategic directions to drive those targeted initiatives and make sure that we're, on, that we're being accountable to the performance measures that are outlined in the strategic plan. We've invested in innovation as well. We held a request for a grant application process in in the early fall of twenty twenty four to develop a center of excellence, which is a national best practice. And we'll be working with the Center for Health and Learning and the Vermont Program for Quality and Health Care to implement this Center of Excellence and begin the development of that as well. And then we've improved communication and resources. There will be a Facing Suicide Vermont newsletter, that will be coming out very soon as well, to share updates and best practices. And at the end of this presentation, there's a link to sign up for that newsletter, which I would encourage everyone on the committee to sign up for. And then there's a postvention support pilot as we know over, a a landscape scan that postvention was, support was severely lacking. And so we've been targeted with, making sure that we're building capacity, for postvention, within our communities. And then the Suicide Prevention Symposium, which was held during Suicide Prevention Awareness Month, in September. And that was the first time since COVID that it was held in person and convened, key stakeholders to drive policy research and community action. And so we know that the strategic plan provides the broad vision and mission, and charts the path forward to improve our efforts and alignment. And I just wanted to, segue, to the Vermont Department of Health as I know that we couldn't do this work without, the Department of Health team, and wanted to make sure that they're highlighted as well. [Chair Alyssa Black ]: Great. It's Nick. Nick? It's me. Oh, it's you. Oh, okay. [Stephanie Bloch ]: It's all good. So thank you, everyone. I really appreciate allowing the health department to come and be able to talk about the work we're doing within the health department, both with grants and some of the successes. And before I change to the next slide, I also want to specifically, express appreciation for people that have been involved in the facing suicide initiative campaign because someone's in the room. I didn't realize that you're going to be here. So welcome. [Speaker 2 ]: Oh, thank you. Star. [Member Leslie Goldman ]: Thank you. [Stephanie Bloch ]: So to introduce myself, so I am Stephanie Bush. Again, I work at the Department of Health. I am the principal investigator for both the CDC grant and also the GLS, the suicide prevention grant. We do a bunch of things around it. For sake of time, just want to say we have been fortunate since twenty twenty to have two big federal grants that have allowed us to do work both thinking about suicide prevention in the state from a public health approach. As you can see, the time periods and kind of our focus population, which is, the overall kind of measure we're looking for is a decrease in both injury and death among kind of adults and also thinking about rural, etcetera. Our youth suicide prevention grant is through SAMHSA, Substance Abuse and Mental Health Services Administration. So we got that grant in mid twenty twenty two, as Chris had mentioned. And that runs also for five years. And that's focused there's a couple of different populations of focus within that. But really, both of those grants are working to improve systems, as well as, thinking about kind of that puzzle piece of suicide prevention. It's all these pieces. It's training, it's support groups, bereavement, etcetera. And the next slide kind of talks about a couple of different highlights. So a question that you had asked and maybe you want if you wanna ask again, and I might have some information, but not all of it. [Chair Alyssa Black ]: Sure. Did you wanna ask a question? Yeah. You want to [Member Mari Cordes ]: thank you for the opportunity. I noticed the facing suicide campaign uses CDC grant funds, and sounds like you're in now we know it for the SAMHSA funding. Are you aware? Is the money do you already have the money? Is it at risk? [Stephanie Bloch ]: Yeah, that's a great, really great question. So the thing that was awesome about the CDC grant is it allowed us the time and space and funding to be able to engage people with experience, partners, stakeholders, etcetera, to really think about what would an awareness campaign look like that is a Vermonter sharing the stories of Vermonters and that whole piece around how to promote help seeking, how to help someone who might be struggling. What do you do if you are concerned about someone? And so the the facing suicide initiative was really launched with that funding. We some of the GLS funding will go to continue to support that for continuation because there's been so much amazing work with it. And we're adding some youth focused and family focused stuff into that website. And so depending on how things happen in the future, and all of this is federal funding, it is something that we'll be we are intentionally thinking about and we'll engage our leadership on. [Member Mari Cordes ]: So do you already have the money and it's spent or it's already allocated and technically they couldn't the federal government couldn't claw it [Stephanie Bloch ]: back? So the the funding went really towards in part, like, the creation of the website, which so the website exists. We have staff that are updating it, etcetera. Some of the other pieces that we're actively working on right now, which I will show here, is expanding our, stories of people with lived experience in Vermont. So we're using funding kind of so the initiative exists. The website exists, etcetera. We are looking at these bar or smaller projects with funding that we do have to be able to continue doing that work. Thank you. And there's additional stuff that's can definitely provide additional information in the future. Yeah. So I'll just really quickly say that this work, as Conakra said, would not be possible without our state level partners, our community partners, people with experience being able to really help shape what this work looks like and really coming together to face suicide. So here is a, wanting to not drown you all out with paragraphs and paragraphs of texts. Wanted to kind of highlight in thinking of the different buckets of the work that the health department's doing. There's kind of four buckets and these are some different highlights. And depending on what the committee was interested, I can highlight a couple of them. If you're like, oh, tell me more about the emergency department project, I welcome that. But so in thinking of the work both with GLS and the CDC, we're doing a lot of work around awareness and communications. As Chris said, with the newsletter that's coming out, we've had some really successful work around men therapy, which is an online learning platform, specifically engaging men like adult men. Thinking of connectedness, how can we make sure that people have an opportunity to connect? So we're doing some really amazing work around specific populations that are at risk. So some stuff around overdose and suicide prevention within the construction industry, peer support networks for both farmers, which is a little a little icon there, and first responders thinking about, all the different kind of community strategies. And I do have, because I can't just talk about this, has three pages of different kind of summaries of different work. And we would be happy to come back and provide any additional details because I know that time is very short. From a public health approach, we always try to be data informed and, and evidence based. There is a slide later to both talk about the data linkage project with this. I know the committee has experienced before and our new dashboard. One of the things I think is a really big success is being able to take that dashboard and real time data and give it to our partners so they can utilize it. So it's not just us collecting data and not sharing it out. And then there's a bunch of place based work. So engaging with the emergency department for their kind of systems and strategies, health care, public health care, training, thinking of, like, mental health first aid or CAMs, etcetera. Does anyone have any questions or that would be interested in? [Chair Alyssa Black ]: Too overwhelmed? No. Actually, I was hoping you could go a little bit more into the man therapy because this is not something that I have heard of. And presumably, men, I'm thinking, access this. [Stephanie Bloch ]: Yeah. So happy to talk [Speaker 4 ]: a little bit more. [Stephanie Bloch ]: And I know that we we do have a kind of a one pager about it and can follow-up with any additional information. So man therapy is an online you can think of it as, like, an online educational website that is very focused towards men. And I have some resources that I will happily share with you. And so it is has has anyone ever seen, like, Ron Swanson? Yeah. Very Ron Swanson. [Chair Alyssa Black ]: No. It's Ron Swanson. Oh my god. We don't. So [Stephanie Bloch ]: it's it's really so understanding that in Vermont specifically that a vast majority of our suicide deaths are are men and also firearms are part of that conversation. So it is geared towards promoting help seeking, being able to engage in educational information around mental health, substance use, relationship, etcetera. So they have a a thing where at the beginning, it's like you can do, like, a ten point head inspection. Like, you would go and get your car checked out. You can go and get your head checked out. And we did a paid promotion with that. With with funding, we were able to. And there were over two hundred people that took that the head inspection head inspection. [Speaker 7 ]: I just took it. [Stephanie Bloch ]: Yeah. And and we even have some some information around There's a like a get help now kind of nine eight eight connection. And there were like at least ten people that actually said like, you know, let's let's talk. So that we think that that as a success is developed out of Colorado. It's evidence based. It's not for everyone. As I said, very wrong, Swanson. And I'll give you here, you can look at some of the stickers that you can grab. There's, like, four different pieces. But so it's been it's been a big success. And it's it's a website we pay into it both for a Vermont page specifically, but then also being able to get metrics. Yeah. Do you have any other happy to follow-up just after [Chair Alyssa Black ]: your testimony to go take it myself. But Yeah. Absolutely. I don't wanna skew the data. [Stephanie Bloch ]: Yeah. Cool. And that's actually I I really appreciate you saying that because so it is kinda like I said, very Ron Swanson, very geared towards men and people who care about men. So it's like other people if so it it's it's kinda cool. It's we were able to pilot it for a couple of years, and it really resonated. I think if I remember correctly, I think we looked at Rutland and one other county that I'm not really remember just just to see, like, if it vibes. Yeah. Right. [Chair Alyssa Black ]: Thanks for going into more detail. [Stephanie Bloch ]: If you want any of the stickers, you can have them because we we have plenty to make stickers. So as you're, like, also going through all this and thinking about it, again, happy to, follow-up with any of the questions. So I'm going to touch on some of the data as well. Again, I know in the past, we have provided Brooke specific testimony. Three slides are probably not gonna be answer all of your questions, But I would just let you know so what I wanna say before kind of digging into the data points, I want to recognize that behind all of these numbers are real people. Every statistic represents a story, a person, a family, and our communities that are impacted by this. So we share this data. We talk about this data to help kind of work to reduce the burden within the within the department, but also within the state. So I just wanted to say that real quick. So we like to have our little pyramid around morbidity and mortality. So mortality is deaths. So at the top, in Vermont specifically, there's, about one hundred and twenty five deaths per year. The next one down is, emergency department visits for any suicide attempt. And then after that is an, emergency department visits for intentional self harm. And then the bottom of the pyramid before we add in ninety eight numbers is kind of any suicide related emergency department visit. So this is, looking at our essence data, which is looking at our emergency department visits. It's not the whole picture. We also utilize breakfast, which is adult risk factor data for some of that more upstream work. And then we are also going to be doing a little bit more work around YRBS. So youth risk behavior. And I'll talk to that a little bit on the legal means conversation. And then, while these kind of four pyramids are the standard, I also like to add in the bottom of nine eight eight. So thinking about even before people get to the emergency department. And I know that BMH is gonna talk about many, many things, around the work that they're doing. But so you can kind of see what those numbers are. Very briefly, what I can say is our suicide numbers have gone down a little bit. Our, suicide attempt emergency department visit numbers have gone down a little bit. Our intentional self harm has been kind of the same. And then our overall suicide related emergency department visits have gone up a little bit. And then also our ninety day calls have gone up. So happy with I'm sure there's additional questions around all of that. Happy to follow-up with all the details that you want for the questions unless you have anything specific right this second. [Member Brian Cina ]: Yeah? I don't. [Member Mari Cordes ]: I'm just close to you. Okay. [Stephanie Bloch ]: You're, like, in my peripheral as well. [Member Brian Cina ]: I didn't keep your mind. Sorry. [Chair Alyssa Black ]: We can talk later. I can't hear you anymore. [Member Brian Cina ]: As far as all this information and and numbers, do you keep track of what was used or drugs, weapons? [Stephanie Bloch ]: I really appreciate that, and I would like to ask you to wait three slides. [Member Brian Cina ]: Oh my god. Three slides. Yeah. [Stephanie Bloch ]: I I yeah. So I we'll talk about that in just a second. Yeah. Any other questions for at this second? [Chair Alyssa Black ]: No. I think we're gonna we're gonna Wrap [Witness Christopher Allen ]: it up. [Chair Alyssa Black ]: Well, no. No. No. I wanna get to to Alan's question, so let's go through it because I know that we have other guests in [Speaker 4 ]: the [Stephanie Bloch ]: Yeah. That sounds great. And you're just waiting for it to get [Speaker 4 ]: to the [Stephanie Bloch ]: last line. So I'll just say so kinda quickly as well. So looking at our overall suicide numbers and death rates. So twenty so twenty nineteen was one of our best years, and then I'm not sure if people remember something happened during twenty twenty. Lots of things got disrupted. Twenty twenty one was our highest number of suicide death numbers, in the state and also nationally. And then we've seen, as you can see here, two years of decreases with since twenty twenty one. And what I will also say as well so, as you likely know, our twenty twenty four numbers are not out yet. But currently, I double checked this last night, we have ninety deaths that are by suicide, and there's fifty five pending death certificates. So we are trending lower, but we really won't know until probably, like, April or May. And we're glad we obviously share that with you all. [Chair Alyssa Black ]: Okay. Yes. Just about those pending certificates. They're across fifty five across everything or those that may have a question about methane? [Stephanie Bloch ]: Yeah. That's a great question. So a pending death certificate is just the cause of death has not yet been determined. So that could be there's toxicology. There's other things. It could be that it happened yesterday. Like, so, please do not think fifty five pending means possibly fifty five suicides. But it's Yeah. That's that was my point. Yeah. Exactly. That's a really great question. All pending. Yeah. It just hasn't been finalized, essentially. Yeah. Yeah. So in a question that we often get is kind of how does Vermont compare to the nation? So, as you can see, over the last fifteen years, Vermont has consistently been higher than the US rate. We ranked nineteenth by rate, not count, in the nation. And the one thing I will also add to this is that in twenty twenty two, we saw a decrease and the rest of the nation saw an increase. I think that that is somewhat reflective of all the amazing work that literally everyone is doing. And I'm fingers crossed that, like, twenty twenty four has also been [Chair Alyssa Black ]: a a bit lower as well. [Stephanie Bloch ]: And to answer your other question around, typically, veterans, veterans are three nearly three times as high of a rate to die by suicide in Vermont compared to all Vermonters. And I don't have the national numbers, but I can get [Chair Alyssa Black ]: those for you if you'd like. [Stephanie Bloch ]: So the question that sounds like everyone's waiting for. So one of the things that's also important is talking about legal means. So, do you want to answer your question now or or ask your question? No. Okay. Yeah. So looking at specifically in Vermont, so you can see self harm on the left side. So about half of self harm and so that would be people going to emergency departments are by poisoning. Thirty eight percent is by cutting. And then looking at suicide deaths, a little bit more than fifty percent is by firearm and then suffocation and hanging and then poisoning. What I will also add is that male suicide deaths make up seventy three percent of all firearm deaths. So that could be homicide, suicide, all of those things. So when we talk about the work that we do, one, suicide and also males, which is the man therapy conversation, is important. So we've done a bunch of work around, and I know that you have a legislative ask out to the health department. That is my thing I'm doing this afternoon to talk about all of the things that we're doing. So we have a firearm safety web page that has data, different work we're doing. And what I can also say is that through the governor's challenge and a bunch of our partners, we've given out at least two thousand gun locks over the last, like, year and a half or so and, really thinking about how we engage in that conversation. There's some interesting work that we're hoping to do to really engage people that own firearms, to think about what is that messaging that works, how can we work to really protect firearm safe storage. One of the things that's exciting for this year, unfortunately, it's gonna take a year and a half to get the data, is that our breakfast data, so our adult risk surveillance data is around firearms in the household. We're gonna be asking that this year at the exact same time that we're asking a YRBS question around how easy is it to get access to a firearm among our middle schoolers and high schools. So we'll be able to look at those two numbers together. Yes. [Chair Alyssa Black ]: Sorry. First amendment. I know [Member Mari Cordes ]: we last session, we talked about in the the suicide assessment tools in hospitals. I'm a registered nurse at UVM, so I use it regularly. There was conversation about asking firearms in the house question. Do you know if there has been any movement to involve hospitals? [Stephanie Bloch ]: I will I'll double check on that. So one of the the successes that have been around with our CDC grant is working with VBQHC, specifically with the emergency department. And part of that is around like, we've trained over three hundred folks in CALM, which is, counseling on access to legal means. So there is work. And then specifically, we're doing grand rounds through the governor's challenge with emergency departments and hospitals around, like, lethal means and safety planning is a big conversation. So I can get you specific details. That was part of the thing that I need to send to you guys later today. But yeah. Thanks, Sam. I think [Member Mari Cordes ]: and it might be challenging too. I know speaking of someone at the bedside there Yeah. It's hard to have more initiatives added on to our workload. Yeah. Absolutely. And and I'll say real real quick. So one [Stephanie Bloch ]: of the things that actually has been amazing is our emergency department project work that we've been doing with CPQHC for their systems, and we've actually helped all emergency departments engage in that. So yeah. That's great. You go? [Chair Alyssa Black ]: Yeah. I really wanna get to our next two guests, and we're already gonna head into our lunch. And I'm asking the committee to indulge me in that. And we'll have to Okay. Move on. We will we will pop out for that. Yep. [Stephanie Bloch ]: Yeah. So I just want to so we have more data stuff we can talk about. These are ways to get involved. I would highly encourage you to sign up for the newsletter. Last time I checked, we had about sixty people signed up for it, and that's me coming out. And again, I appreciate your time. Apologies for going over, and we'd love to talk more. [Chair Alyssa Black ]: We got you started late. Thank you for coming in. I know we will probably have you back in at some point this year. Really looking forward to the numbers for twenty twenty four, because as you're aware, you know, this committee did a lot of work around, you know, trying to make a dent in that. So it would be great to sort of see updates. Yeah. And it's great to see all the work that you've been putting in. I you know, Chris put up the timeline, and I was like, oh my goodness. My life is flying by. It's a visual representation because I, you know, I remember it along the way. So thank you. Thank you, Chris. Thank you, Nick. Here you are, chair. And And thank you for [Speaker 4 ]: the diligent collection of data. This program does the awesomest collection of data. I really appreciate that you all do that and have it, publicly available [Chair Alyssa Black ]: on your website. I know. Yeah. And, I mean, [Speaker 4 ]: you know, the data informs, [Stephanie Bloch ]: you know, where the programs need to go. Yeah. Absolutely. And therapy. And our updated slides should be available at the end of this month, but they're not Thanks, Jill. [Chair Alyssa Black ]: So I'm going to try to get to our next guest, Judy Seiler. Oh, there's four? Oh, well, I'm maybe topper's still copying. It's oh, we have four. Alright. Well, if if we'd like to get started, I hope everyone can just sort of jade free. Yeah. Okay. Yeah. Judy? So so [Speaker 4 ]: so so so so [Chair Alyssa Black ]: That's right. Please go ahead. I do. And I hope we see that. Would anyone like to sit up there together? Yes. Yes. Yes. Exactly. Yeah. Yeah. Because as people Exactly. So I'm I'm going to give just sort of a timeline. Too many some people may have to leave, and that's okay. Yeah. So let's try for five minutes apiece and we'll extend till twelve ten. Okay. Great. Thank you. You're welcome. [Judy Seiler ]: Thank you for having us. My name is Judy Seiler, and I'm the president of the board of NAMI Vermont. I've been involved with NAMI over ten years. I had an an uncle with mental illness who was a famous professor, a brother with mental health issues, and, we have a daughter adopted from Russia. And so I have a long history of it and used to have seasonal affective disorder myself. So, with NAMI, I've taught many classes. I'm a train the trainer for people to teach our signature program. I'm a train the trainer for people to teach support groups. And so I get to talk to a lot of people in the community. The family to family class I interview, I spend hour more on the phone with anybody that's interested in the class. So last year, I spoke to over a hundred families. And so, you know, what we're hearing from families is a lot of isolation, still a lot of stigma and, fear. There's a lot of families, that are in their sixties, even seventies, and they'll have a a a young adult or, you know, could be somebody in their forties or fifties, and they're not able to live independently. They're you know, I mean, not everybody's mental health does not keep them from living independently. As I said, my uncle was a professor. My brother was an engineer. But there are folks that aren't able to live independently, and they're not able to be safe in the community. And so these families are saying, what are we going to do? Because there's not enough community support. Way back when [Speaker 4 ]: they said we're gonna get rid of [Judy Seiler ]: mental health institutions, you know, hospitals, and we're gonna have community support. That never really happened as, you know, all of us. We all have families, loved ones. So that is one of the things that they asked me to advocate for. Is there any way we can have some kind of happy thing? Because when you you pay you have a therapist that works with a good hospital, that is way much less money than the ER visits. You know, it's, what, sixteen hundred dollars a day when you actually have to go to the retreat. So to keep somebody out of the hospital, out of the ER, safe, and able to work in the community. Often, these people can work part time or some of them can even work full time with support. So that's something that is a really critical need for anybody, anywhere in the state, anywhere in the country is to have some, [Chair Alyssa Black ]: a support system where you [Judy Seiler ]: can live independently, but there is support. I know a group of families that have some loved ones with disabilities that they just actually bought a property, and they have about five households that are sharing support of their loved ones. It's, I think it's in in, in Dumber Center Putney, they they bought the property, but what we need is, you know, help with that. And then an, and so then another thing that I'd like to talk about today briefly is there's a block grant for writing up something for early psychosis. Well, we already have an evidence based program. The family to family class is over twenty years old. It has it is absolutely evidence based statistics, national statistics. It's taught it was created. People probably don't realize it was created in Brownborough by Joyce Berlin. So it's a Vermont thing. It's taught all over the United States and in other countries. So to spend the money to create another program when we have this is so educational. People take family to family and they're frustrated, they're angry, they're confused. And then after the class, they have empathy and they have understanding and education. And they we we tell them about resources, you know, what you can do, what Vermont offers. You know, it's educational. How do you talk to somebody? You know, somebody is in crisis or somebody is upset. How do you talk to somebody and make them feel listened and cared for? So we have this program already created. So for that block grant to go out in a station or from scratch, you know, our NAMI's family to family class is updated every couple years. There's new science. There's new education. So it's not like an old program. It's we keep it up to date all the time. And we and we we rep we don't it's not like a cure all. We tell people, this is what else you can do. This is where else you can go. So it's resources and education. Please. [Chair Alyssa Black ]: Would you mind sending us your that block grant in writing? So we have it. [Judy Seiler ]: I'll get I'll get Laurie I'll get Laurie to the phone. Yeah. [Chair Alyssa Black ]: Who wants to go next? Right. [Member Leslie Goldman ]: I'll be just a couple minutes. I am Dodie Gerard, and I am am a mother, a wife, a writer, and a continuous survivor of mental health conditions. I live with bipolar disorder, PTSD, and paranoid hallucinations. I've been hospitalized over forty times, so I know what hospitals are like. I'm disheartened that central Vermont is closing. I'm just gonna leave that there. But, I just wanted to share that I went to a hospital. This is my latest book that came out called The Long Haul. This is one of the hospitals in Vermont that was not a good it wasn't clean. It wasn't there was staff that I mean, it's hard to get staff now for everything, right? And so there were some people that think that they can [Speaker 7 ]: kind of tell you what [Member Leslie Goldman ]: to do all the time. They don't give you enough freedom, right? I mean, you're not free, but I mean, choices. So for example, I wrote this while I was there, but every day they said the staff said, you get three pieces of paper as allotment for the day. [Chair Alyssa Black ]: And I said, that's the thing. Right. [Member Leslie Goldman ]: And so they said, no. That's what you get. You get three computer pieces of paper. And so I think my first three page pages wrote three poems for three other patients to see beyond their despair, to see them, something beautiful about them. And then they in turn said, Jody can have my three pieces of paper alone. And so we got around that. But isn't that disheartening? I mean, what if paper I mean, they had a big stack like this, and they counted up three. I don't know. It's just ridiculous. But what I did when I wrote this was the hallway, the one thing that was beautiful about the place was that they had Vermont photographs from John David Geary, who's a Vermont photographer, and they were all landscapes of Vermont. So I chose to jump into the photographs in the hall and write about meeting my love, my husband, and meeting my younger self in these beautiful places besides where I was. And when I left the place, I spoke with Ann Donahue, and she said you've had an emergency meeting, and you decided you were going to do random inspections there now, which you weren't doing. I paid up my friend's cleanliness. I don't know if that's still happening, but because it was sort of state supported, I just thought it was hard for the ones that were still there. I wasn't there very long, but it was very sad to be in a place where the windows were black. That's unnecessary. You know, that's very unnecessary. You have a there was a beautiful mountain. We couldn't see it because the windows were black, and that's just disheartening. Mold and paint mold in the bathrooms, that's just not acceptable. And so I talked to Anne Donahue, and she said, let's try to do something. So then eventually, I just recently this year published this book about it. I'll just let you go around with it, if online or whatever. But, I really appreciate you wanting to listen, you wanting to and having people be heard, and that's what I'm trying to do. So thank you. Thank you. [Chair Alyssa Black ]: Thank you. And, Brian, did you have a real quick question? [Witness Christopher Allen ]: Which was this the old stay hospital, or was this the new one or a different hospital that you're talking about with the cleanliness issue? [Member Leslie Goldman ]: Is it okay for me to tell you where it was? [Witness Christopher Allen ]: I think so. [Member Leslie Goldman ]: I don't say it in the book. [Speaker 4 ]: I'm wondering if [Chair Alyssa Black ]: that's exactly If [Witness Christopher Allen ]: you wanna tell me off the record, you can if you're worried [Speaker 4 ]: about it. Interested. [Member Leslie Goldman ]: It was just before COVID at Bridalgo retreat. [Chair Alyssa Black ]: Okay. Yeah. [Speaker 4 ]: I don't use Amazon, but do our local bookstores like Phoenix Bookstore carry your book? [Member Leslie Goldman ]: Not yet. No. I I I'm selling them as well. K. Yeah. Jodi, direct [Speaker 4 ]: I'd love to see it. Get in some local bookstores. Yeah. Congratulations. Congratulations. [Member Leslie Goldman ]: Yeah. I'm gonna go reach out to them, but mostly it's online right now. [Chair Alyssa Black ]: Thank you. And thank you for coming in today. Thank you, Diane. Thank you. [Speaker 2 ]: Hi. Good morning. Or Yes. Good afternoon. I'm going to just read my what I typed up really quickly to save everyone some time, and I appreciate the opportunity to come here today and to meet all of you. I've been married for about thirty eight years, which in today's society is like, what? Blah. Yeah. I'm also the parent of three children, two of which have disabilities. I wanted to sort of share with you my experience with mental health. And it began at an early age. I was one of six kids and two being from my mother's previous marriage. Sorry. Can you share your name? [Stephanie Bloch ]: My name is Laurie Moffett. Okay. Sorry. Yeah. [Speaker 2 ]: Go ahead. Sorry. And I hail from Bennington, as I think I mentioned, but, so anyway, I never really got to know my oldest path brother, because he was went to live with our grandparents early on and, and, you know, I was told it was due to his unmanageable behavior. His visits over the years were always memorable to me. Despite my desire to be close, he treated all of his younger siblings with nothing but kill time. It wasn't until I was much older when I was told that he was sent away because he actually tried to smother our youngest sibling with a pillow. Eventually, he would receive the diagnosis of narcissism and paranoid schizophrenia, which way back when was, like, tacky. He refused to accept treatment and burdened my mother with his on demand need for support via phone. And I myself became her substitute at times. And I can remember women being on the phone with them over five hours, listening to him tell me about how women talk and code and about how people were stealing medication out of his home. My half brother was belligerent towards health care professionals, and they refused to work with him in an arbitration. This made it very difficult for the continuity of care. Over the years, his symptoms increased and included, an attempt to harm itself and for my mother. There was a SWAT team visit to our home while we weren't there while my mother and I were on vacation because a friend of his called for Wolf Jack on him, and he showed the door of a police officer. So needless to say that our neighbors weren't too happy. My helper, you know, he really made it very difficult for the rest of the family. We even had to when he was living in Florida, we got calls from neighbors saying he was acting erratically and we had to initiate the bank draft on him. He was released within three days. So despite all the attempts to get him the support and treatment that he needed, unless the individual is willing to engage and unless you reach another early age, it just doesn't happen. And he never got that support because mental health services didn't exist for children that bad, nor did he wanna receive a diagnosis when we talk about schizophrenia. So, you know, it, really was a challenge growing up, with having this past sibling that nobody talked about. As a child, my dad was away often, so my mother was the one in charge, and, she was very strict. We always tried very hard to tease her by meeting her expectations. I love my parents very much. However, I never realized my mother was so unkind, even while being an asshole that she wished she had drowned the soul of a child. In the middle middle and high school, I lost two close friends to different blood diseases, two other friends to suicide, and another friend from an epileptic seizure. Back then, there was no such thing as school counselors. You know, it just didn't exist, or to help us process when our friends died. Our families didn't talk about mental health or family members' need of psychiatric services. Mental health services for children seemed to be nonexistent. The stigma associated with mental health diagnoses was overwhelming, let alone the horrific misperceptions associated with a diagnosis such as schizophrenia and paranoid schizophrenia of that. This often resulted in the entire family being ostracized from friends, family, and community. Growing up as a tall, big girl, I can assure you there was no one I could talk to about the bullying and discrimination I experienced. There was no one to help me process the feelings of rejection from not just my oldest stepbrother and my mother, but from my other brother who would drive past me as I walked over the place, you know, and I and told me never to tell anyone that we were related. To be honest, Steinron never really gave any of this any thought. My childhood experiences were just that, child my normal childhood experiences. And now I know that those experiences impact you well into adulthood. As a parent of two children with disabilities and mental health diagnoses, I attended workshops, seminars, trainings, conferences, anything I could to learn the terminology and understand how these diagnoses and deficits impacted their ability to develop, learn, communicate, work, maintain interpersonal relationships, and live independently. I attended weekly counseling sessions for twelve years to ensure that my children had access to the best possible psychiatric care we could provide and throughout their development, which they or we, when they or we needed it most. Having grown up with mental health services available, I can attest to the value that these services can bring to a family. My own children. We feel fortunate that we've been able to access mental health and other services across the state in support of our children. However, the same cannot be said for many other families living in Vermont. As a member of various boards and committees for many years, providing family voice into the system of care, I've heard countless stories shared by individuals experiencing severe childhood trauma, often leading to addiction, sexual abuse, incarceration, and suicide. I've listened to families describe the barriers preventing them from accessing appropriate mental health care, such as generational poverty, economic discrimination, lack of providers, lack of insurance, cost of insurance and phone pays, no transportation, homelessness, etcetera. Becker, I just would like to ask that you continue to listen to the families of the Vermont sharing their stories and support them by doing what you can to increase the amount of funding available for mental health services so that all families can access the care that they need. Thank you for your time and consideration. Thank you. Thank you so much. [Chair Alyssa Black ]: If you can submit that. I will. I thought you'd say it would be wonderful. Can I [Judy Seiler ]: can I tell you something really quickly because of what, Judy shared about the hospital? My daughter, who they never thought would even get through high school with her mental health issues, who's doing amazing. She's almost done her master's in clinical psychology now. Wow. Great. Great. She's incredible. She's working at the psychiatric ward part time while doing her master's in Rutland, and it has now become so dangerous that people, the nurses are quitting. On the one wing, there's a patient that my daughter who's this little skinny thing has to smash out of the way. And the male doctor, she said, are resigning because he's so dangerous. And a male male nurse rather was just seriously, seriously injured this past week. Wow. Given my daughter [Chair Alyssa Black ]: has blood stress. And I will say that we're we've had ongoing discussions around workplace violence and health care, and we will be I will commit to the committee. We will be taking testimony on this relatively shortly. [Speaker 4 ]: Okay. What about the inpatient unit at relevant? You're talking about the inpatient unit at relevant? [Chair Alyssa Black ]: Yes, I am. [Speaker 2 ]: Thank you. [Chair Alyssa Black ]: I'm sorry. Did Lisa want to quickly? Lisa isn't here. Okay. Well, thank you. Thank you so much. And I and I'm so sorry that we were that we transcended to our yes. Look. Daisy wanted to say There's another person here. Oh, anyways. I'm sorry. Yeah. [Stephanie Bloch ]: Did you wanna have a seat? [Speaker 7 ]: Yeah. Sure. I just never done this before. [Chair Alyssa Black ]: Oh, absolutely. Yeah. Welcome. Hi. Thank [Judy Seiler ]: you, for your time [Speaker 7 ]: and consideration today. My name is Jeanette Langston. I am the founder and director of Social Chinquering, the Human Connection Project. We're based in Rutland, Vermont. How about you? Aren't you I'll just start from the beginning. I I I know. Forget. Have you ever felt alone? Like, no one really cares. And have you ever felt like you didn't fit in somewhere, like you weren't part of the cool crowd and didn't have anyone you can count on to talk to? Do you know someone who has a hard time leaving their home? Maybe they can't drive or walk down the street easily. Maybe Maybe you know someone who faces discrimination on a regular basis because they're a bit different than the people around them. Or perhaps you know someone who has been dealing with family estrangement and feel like no one really understands them. All of these and more are reasons that approximately half of US adults report experiencing loneliness with some of the highest rates among young adults. And this is from our twenty twenty three, our epidemic of loneliness from the outgoing youth surgeon general, Doctor. Vivek Murphy. The American Psychiatric Association's Healthy Minds poll in January twenty twenty four showed that thirty percent of adults say they have experienced feelings of loneliness at least once a week over the past year, and while ten percent say they're lonely every single day. Younger people are much more likely to experience these feelings with thirty percent of Americans aged eighteen to thirty four saying they're lonely every day for several times a week. So today I'm here to talk to you about connection. It's a critical human need that is not being met for many people and how it's causing the epidemic of loneliness in America. We often talk about isolation and loneliness, but there's actually a further upstream, and that is lack of connection that is causing the isolation and [Chair Alyssa Black ]: loneliness. This [Speaker 7 ]: is impacting all of us here in Vermont and our communities and all the different ways that we see through all the different issues our communities are facing. In twenty twenty one, my team and I formed social tinkering human connection project based on our own life experiences around isolation and loneliness and how we found that connection helped us each other to live. [Chair Alyssa Black ]: I'm very sorry. I'm gonna have to interrupt you. I I don't believe I'm not sure you've communicated with our committee assistant to go on to the agenda. We can certainly make time for you a little bit in the afternoon if you wanted to speak. But, you know, we we do have a schedule and a protocol for testifying. [Speaker 7 ]: Yeah. I actually was told I was on the schedule at twelve fifty. I mean, excuse me, eleven fifty today. Okay. And I sent an outline of my talk, and it was received. [Chair Alyssa Black ]: Why don't we communicate after this and then see if we can get you sometime this afternoon? Would that be okay? [Member Mari Cordes ]: You do that, and I'll be great. [Chair Alyssa Black ]: I mean, come in. You. Easy. Did you wanna wrap did you have, something to add? I was just gonna [Speaker 4 ]: add, that there are so many wonderful stories like those that we just heard. And if you wanna hear more committee and, yeah, folks on the side, head down to the pavilion in the Supreme Court area. And there is an entire day of, mingling with folks and learning more about mental health, down there with NAMI and other advocates. Thank you. Thank you for your time. [Chair Alyssa Black ]: And we can go offline.

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