SmartTranscript of House Judiciary - 2025-01-29 - 11:15 AM

[77 seconds of silence] [Chair Martin LaLonde ]: One ninety two, I think. Pardon me. The room audio, it's muted. You did. Okay. Alright. Alright. So Okay. Welcome again to to to the health judiciary. So we're gonna get background on on s one ninety two, where we ended up with that, because I know that was kind of the latest effort to get a forensic facility. But if you could talk a little bit about that higher level, yeah, the higher level of need for secure residential treatment [Michelle Childs ]: Sure. [Chair Martin LaLonde ]: And how that fits into the criminal justice system. [Michelle Childs ]: Sure. But also legislative council, and I see you have many returning members, so I open them for you. Welcome. Yes. [Karen Barber ]: Never It's all for you. [Chair Martin LaLonde ]: Oh, god. [Michelle Childs ]: I have to say I'm I do appear here occasionally, but I spend most of my time with your colleagues upstairs in health care and human services. My staff issues related to mental health and individuals with disabilities, which is why I'm here on this particular bill, but why you don't see me all the time. So I thought it might be helpful just to, like, step back and remind us what we're talking about and which is, individuals being in custody of either the Commissioner of Mental Health or the Commissioner of Dale, Disabilities, Aging, and Independent Living. And there are lots of ways that people can be, become, under the custody of one of these commissioners. For example, in a mental health context, somebody could come from the community. There could be an observation by a therapist. It could be an observation from anyone in the community, a law enforcement officer, that perhaps this person has a, is having a mental health crisis. Maybe, they need to be receiving treatment in a hospital, and that person is transported into a hospital for an evaluation to see if they need involuntary treatment. So people can come in through the community, but that's not what we're talking about today. We're talking about people coming in through what I call a criminal justice store. So these are individuals who have likely been charged with a crime. Maybe they've been deemed not competent to stand trial. And they still, but it's apparent that they need care in custody in the custody of a commissioner of mental health or of Dale. So just to sort of focus us on the population who we're talking about, When we were, when the idea of a forensic facility was floated, just because somebody has a mental health condition or an intellectual disability and is not competent to stand trial, or maybe they were found that they were legally insane at the time that the crime was committed. That doesn't necessarily mean that they would have been a candidate for a forensic facility. The definitions that this committee and other committees were looking at also can show that there is an indication of violence on the part of that individual too that would warrant a higher level of placement than maybe a hospital or a community placement could provide. So the legislative history around the concept of a forensic facility, as this committee knows, it's kind of long. The idea has been floated for a few bienniums. The first year of last biennium twenty twenty three, there was a proposal to create a forensic facility, for individuals with mental health conditions and adult mental disabilities. That was act, to check my notes, twenty seven. It's Act twenty seven. It came through the Senate. It started in the Senate, came through the Senate with a forensic facility. This committee, human services and health care all looked at the proposal. And in the end, it was sort of decided that the House wasn't ready to make that decision to have a forensic facility at that time. So instead, what happened was a work group was created to look at the concept of a forensic facility, specifically with regards to whether individuals with intellectual disability should be in the forensic facility. So in general, in this body, there has been historically more support for forensic facility for individuals with mental health conditions than with intellectual disability. And there's been concern about having two populations being served together in the same facility. So that has sort of been what a lot of the date debate has been. So I posted that act for you so you could take a look at it. That's Act twenty seven. Fun note for anyone who might be interested in working on a miscellaneous judiciary cleanup bill. As I was going through the bill last night, that bill, that act anticipated that there would be a forensic facility in the future, which we know did not happen. Act five Why don't I just pull it up? Because I have it here. Act five Section five. Do I have this? Okay. So section five asks for a report anticipating that a forensic facility would have been created one year in the future. So it asked for a report from BMH and Dale. Each year, the average daily census at the forensic facility trends over time, the number of individuals waitlist waitlisted for their forensic facility, aggregated demographic data about individuals served at the anyway. So you can see that this is an annual report that is asking for data that you don't have because you don't have a forensic facility. So if you are interested, this could be a candidate for a repeal in sort of a miscellaneous cleanup bill. [Chair Martin LaLonde ]: Could you send that to Eric Fitzpatrick? He is the keeper of the miscellaneous bill, and it's starting in the senate. [Michelle Childs ]: Oh, okay. [Chair Martin LaLonde ]: So so, yeah, that that [Michelle Childs ]: apply that for okay. I'll write a note to myself. Okay. So so the twenty twenty three act, it anticipated there would be a forensic facility. There were requirements that rules we put in place. We started putting the reporting in place for forensic facility. And then the sort of the piece of folks who are not, coming to consensus around was the intellectual disability piece. There is a task force that was required to look at that issue, if that was the correct place for a person with intellectual disability, and criminal justice involvement and some indication of violence. Is that the best place for that person to be treated? That that group met. The recommendation from that work group was no. I don't think they exactly found consensus. There were some mixed opinions, but predominantly there was a feeling that was not the right setting. Last year, twenty twenty four, the idea of a forensic facility was not was not dead. It was still very much an actionable idea. Again, the bill started in the Senate, and it had the same proposal that had been discussed the year before, which was a forensic facility that would treat individuals with mental health conditions and with intellectual disability. It passed that way out of the Senate. And then it came here and we sort of had a repeat of what we had the previous year, which was once the three policy committees got involved, sort of the same concerns were raised around individuals with intellectual disability being treated at a forensic facility, having two different populations being treated at a forensic facility. So as different committees were hearing testimony about the bill and considering this issue again, Question was asked in one of the committees. We already have what's called a secure residential recovery facility. How, is this population, could this population be served in the secure residential recovery facility? I should back up and say what the Secure Residential Facility is. So, this is a facility, that was required in Act seventy nine of twenty twelve. The idea is that it was for individuals who are leaving a psychiatric hospital setting. They were stepping down to a lower level of care. Oh, my battery is low. Okay. Do you have a I don't know what you over here. Wow. [Chair Martin LaLonde ]: I think [Michelle Childs ]: you have that word. [Angela Arsenault ]: Thank you. Success. [Michelle Childs ]: I hit the ground running today. Haven't even been to my office yet. So so the idea of secure residential was that individuals would come from a hospital. They would step down to a secure residential recovery facility. It created a more secure setting than many of the step down facilities, often because of maybe the individual's more violent tendencies. They needed to be in a secure setting. At the facility, there were not emergency and voluntary procedures performed. What are those? Those are seclusion, restraint, and restraint means either physical restraint or chemical restraint, meaning like an emergency medication. And also there wasn't, like, court ordered medication, so involuntary, non emergency court ordered medication at that facility. And those EIPs, emergency and voluntary procedures, and involuntary corduroy medicine would have been allowed at the forensic facility. So the conversation sort of shifted to be, could we make the secure residential recovery facility into a facility that could better treat this group of people that the forensic facility would have treated. So what passed last year started off as an act relating to a forensic facility, and it ended up with a completely different title. Where did it end up? And actually leading to civil commitment procedures at a secure residential recovery facility and a psychiatric residential treatment facility for youth and civil commitment procedures for individuals with an intellectual disability. So totally, the bill completely changed. What ended up passing is that the Secure Residential Recovery Facility could take someone even if they were not stepping down from a hospital level setting. So if they would be in the custody of the Commissioner of Mental Health, but they are not, they didn't necessarily need a hospital level care before stepping down to a secure residential recovery facility. Involuntary medication is allowed, court ordered medication, and also emergency and voluntary procedures, seclusion, restraint. So that was all allowed and what passed. So there are some shifts around how the secure residential recovery could be used. Separate to that, the administration brought a proposal about the creation of a psychiatric residential treatment facility for youth. And that ended up being sort of dealt with in this same bill. This is a new type of facility that the state hadn't had before. And so this bill created sort of like a licensing procedure, exactly a licensing procedure, that would dictate what criteria have to be met in order to get a license to operate this type of facility. [Chair Martin LaLonde ]: Is that the Green Mountain Youth Campus? Is that what [Michelle Childs ]: I'll ask Karen. I don't know. Karen, do you know? [Chair Martin LaLonde ]: Karen Barber. [Karen Barber ]: Yes. Good morning. Karen Barber, general counsel for the Department of Mental Health. No. We anticipate the PRTF will be opened at one of the units at the Broad River retreat. That's where we're in the [Chair Martin LaLonde ]: Okay. On general. Yep. [Karen Barber ]: They have a COD right now, so that's kind of it's in the COD stage, but yes. Right. [Chair Martin LaLonde ]: Thank you for clarifying this. Sure. [Michelle Childs ]: So that facility was created. A lot of the act is, I don't wanna call it cleanup, but it extends rights around individuals in the care and custody of the commissioner of mental health with regard to being in a hospital setting to people who are also in a secure residential recovery facility setting or the psychiatric residential treatment for youth setting. So it kind of makes various rights consistent across the types of facilities. And then as we've sort of discussed and made clear, the secure residential recovery facility is not for individuals with intellectual disability as their sort of primary diagnosis. So the question of what, what happens to people who would have been in a forensic facility is and was still an open question. But in the process of working through this issue, human services upstairs took a closer look at, the civil commitment procedures for individuals with intellectual disabilities. So there was a lot of cleanup that was done there, and that is a big portion of the bill that those statutes hadn't been reviewed in a number of years. Trying to think of some of the specifics that came out of it. There was reorganization. There was a lot of attention paid to the definitions, opportunities created for a person who was under commitment to receive a court assessment of whether they should continue to be in commitment after a shorter duration. So those were some of the types of changes. But then sort of the piece at the end is like the sort of the outstanding question that is still in play. And that sort of I think it was maybe the second to last section was a paragraph that Dale is welcome to bring a proposal to the General Assembly about whether and how there should be some type of alternative placement for individuals who with an intellectual disability who would have been at a forensic facility. And that is sort of an open question if and when they want to bring that proposal to the General Assembly if the need exists. So that is what was in the act. [Chair Martin LaLonde ]: And I don't think we've seen anything from Dale. [Michelle Childs ]: Unless there's something in the budget. I haven't heard anything yet. [Chair Martin LaLonde ]: And, also, I know, Bill, that it asked for a study on cost for a competency restoration program, which I'm Oh, great. I'm pretty sure that that was submitted, I think. [Michelle Childs ]: That was submitted. Do you want me to talk a little bit about [Chair Martin LaLonde ]: Sure. Yeah. That would be that would be great. [Michelle Childs ]: Okay. So separate from I I feel like these two ideas sort of become conflated a bit, the forensic facility and competency restoration. But if we can sort of keep them as two separate ideas, a competency restoration program, Vermont does not have one, but some other states do have them. And the idea is if somebody is found not competent to stand trial, because of mental illness, because of an intellectual disability, that they could participate in a program that would help them to become competent to stand trial. And so there was a report, I wanna say two years ago, that sort of evaluated how effective competency operation programs. Off the top of my head, I'm remembering that it was more effective in regaining competency for persons with mental illness. And it was sort of a longer road and more in-depth for individuals with intellectual disability. And then that nothing has been really acted on to create a competency restoration program, but to keep the ball rolling, I guess, for individuals who are interested in pursuing competency restoration within the General Assembly. There was this language added for a fiscal assessment of what it would look like to create a competency restoration program. Would it be residential? Would it now be residential? And it sort of addresses those factors. [Chair Martin LaLonde ]: So just to back it up a little bit. So forensic facility, we're not I mean, we have the secure residential facility. It's essentially forensic facility by another name. Is that correct? Or is there some significant difference that we didn't get with the forensic facility or with the secure residential facility as opposed to forensic facility? [Michelle Childs ]: That it's interesting because I I think, in general, folks in the building struggle to understand the distinction as the bills are moving through. I think now with some of the changes that were enacted last year, the secure residential recovery facility can do a lot of the things that the forensic facility would have been able to do, like the court ordered medication. I I guess they would defer to the department if there were other distinctions. [Chair Martin LaLonde ]: Yeah. It was definitely gonna go to Karen Barber, and she even has her hand raised. So Great. So I was definitely gonna go to you, Karen Barber, on that and a couple other questions as well. But go go ahead. Would you want me to [Karen Barber ]: wait till the end? I could have a No. No. [Chair Martin LaLonde ]: No. No. Let's please go ahead and weigh in on that. [Karen Barber ]: Thank you. So from our perspective, we do wanna be clear that River Valley is not a forensic facility. It is not a forensic facility by another name. It is not intended to be be a forensic facility at all. A forensic facility really when the proposal came about, it came about because of a couple reasons. Right? So in our system, our facilities, we are based on clinical need. The public safety is not a factor we consider. Now, Dale, when they have people under act two forty eight custody, that is part of that. But from ours, because we use Medicaid funding, because of how we are licensed, because of how the Americans with Disability Act reads. Our job is to serve people in the least restrictive setting. And when they are in our facilities, there's a clinical need for that. The idea behind a forensic facility was that there are some folks that would not meet criteria to be either in the hospital or in the secure residential, but there was still a desire from a public safety perspective to have them receive treatment in a locked setting. So that that hasn't changed. That is still not something if you are at River Valley, you are at River Valley because you have a high clinical need, and, clinically, you need to be in the program. We do not accept the referrals to River Valley are not different now than they were before. What what's different is that we now have more tools that we can properly serve. And I also wanna make clear that people who are in River Valley are both what you would call forensics, so coming from the criminal justice system, and people coming in through the civil system. We do not have separate separate units or separate for folks. From our perspective, it doesn't matter where they come from. It's their clinical need. So we already did have people being served at River Valley who had been found incompetent. We very rarely have folks in Vermont that are found in Sains. We didn't have anyone there, but but certainly competency. So, again, it's really about their clinical need, and now we just have better tools. I think when we started talking about did we need a forensic facility if we weren't going to include the Dale population, we thought no. The idea was that we would break down silo silos and better holistically serve this population because there is a lot of overlap between folks that have intellectual disabilities, have mental health issues, and are in the criminal justice system. DMH has facilities, including locked facilities to serve individuals with mental health. Dale does not have any sort of locked facility. And so, really, we were trying to think about how could we better serve those populations and think about the public safety concerns that were being raised. Does that help answer your question? [Chair Martin LaLonde ]: There was a lot there to to to to to back. So just one follow-up question though, just to make sure I understand. So the forensic facility is specifically for individuals coming from the criminal justice system that had high clinical needs and high, public safety requirements. Is that correct? And that's the distinction with with the recovery the secure residential facilities. Am I did I understand that right? [Karen Barber ]: Yes. I think the idea was that you could you could hold people longer than clinically we could now. Right? So right now, in any of our facilities, once they no longer meet that clinical and legal threshold, we have to discharge them. I think the idea was that if you had a facility that was general fund, so not using Medicare or medic Medicaid funding, not licensed in a particular way that had those really high clinical thresholds, you could hold someone longer for public safety reasons versus clinical reasons, which is not allowed when you're using Medicaid funding and you're licensed a particular way. I think one of the issues that hadn't been resolved and that was kind of a sticking point was how would this forensic facility be licensed? Because we were talking about licensing it as a therapeutic community residence, which is how River Valley is licensed, which has those same clinical thresholds. So though that's kind of a a place we never really got to, but I think the idea was that you could have held someone longer than maybe clinically they needed to be locked, and it would be more of a public safety decision at that point. [Chair Martin LaLonde ]: Okay. So it's it sounds like it's as much as anything. It's the funding streams and and Medicaid restrictions. So okay. Funding and licensure. And, yeah, licensure. So is there a continuing are are we fulfilling the needs that we have right now for that high end, high care population with with the secure residential facility, or are we gonna be seeing some time again continuing request for a forensic facility? [Karen Barber ]: So we have not put forward a request for a forensic facility this year, DMH. I cannot speak to Dale. I know that they have been having conversation about what they need. So I can only speak to our population. Yep. We mental health has a fairly robust system of care. Right? And so we do have locked settings. And so I think where the rub is is that if you're coming into our system, it's because you need mental health treatment, and that could mean in a locked setting. There are individuals who are have criminogenic behavior, right, who are committing crimes not related to their mental illness, whether or not they have mental illness or not, that aren't going to be able to be served in our system. That's true no matter what. However, I think, generally, if someone needs to be in our system and they need to be in a locked setting, we have the ability to do that. Now that we have more tools at River Valley, we can serve more individuals. Frankly, we see more we see folks that come in through the civil path have much higher numbers of EIPs and need for involuntary medications than those coming out of the criminal justice system. There's kind of this thought that if they're in the criminal justice system, they're more dangerous, but that's not actually what we see in the data. So this helps us a lot on the civil side. This wasn't just for for the forensic population. So I I think we do a fairly decent job. However, there's always going to be concerns that there are folks that don't fit into our system because our system really is based on mental mental health needs versus it is hard sometimes for people to see people commit crimes, and they assume, right, it must be mental illness. How could you do this if you're not mentally ill? Or they do have mental illness, but that's not what's causing their behavior, and we can't fix that part of it. Right? So people may be discharged from our system and remain dangerous for reasons other than mental illness. But if it is mental illness, I do think we have a fairly robust system to help provide that treatment in different levels of secure settings. [Chair Martin LaLonde ]: Okay. So, Barbara, do you have [Michelle Childs ]: a question? Go ahead. [Barbara Rachaelson ]: I mean and, actually, I'm hoping you can help me remember, but we were hearing from folks, and I'm trying to remember in which setting, if it was, like, the constituent meeting you came to, that there were issues with [Chair Martin LaLonde ]: the [Barbara Rachaelson ]: the court ordered medication process. Do do you remember hearing that? Like, people were feeling frustrated about the process. And I'm just wondering I need to try to go back to my notes to see, but I'm just wondering if, from your perspective, if you've been hearing bumps in the process. [Karen Barber ]: Sure. So I think that's a complicated issue that, people have very strong opinions about. [Barbara Rachaelson ]: Yes. They do. Yeah. Vermont [Karen Barber ]: is somewhat unique in how we do involuntary medications. Not that every state does it the same, but in a lot of states, it's a purely clinical decision. Right? So someone is involuntarily, you know, ordered to have involuntary treatment, and it's their physicians that are making these determinations about whether or not they need medication. Sometimes it's an administrative process. In Vermont, it's it's an additional step beyond someone being involuntarily committed. Right? We have to go back to court. There's different evaluations that have to happen. And judges have the authority to go against and kind of make their own decisions in terms of what medications they're gonna order. So it could be that we have doctors that go in and we say, this is what we need. Legal aid goes in and says, no. I think we could do this. And the judge just makes an order in about what medications they are going to order. That is fairly unusual in terms of how most states do medications. There's also in Vermont, there are timelines. Right? There, there is a way to expedite medications. I think from some people, you will hear it takes too long to medicate individuals. Some people think it doesn't we don't have enough time. So I think it depends who you speak to. The department has not asked currently to look at those timelines. We we have kind of explored it in the past, but it's certainly something we hear about often from both sides. I will say when someone comes in through the criminal justice system, it is a little trickier because in order to get medications, they have to be on an order of hospitalization. And when someone comes in from the criminal justice system, often they're not they're on an order for evaluation. And so often it could take months to get a hospitalization order if we ever get one. So what we started to do is we we EE someone. We start the civil process so that if they need meds, we're starting the process in family court so we can get them meds. So we have that kind of workaround for the criminal, justice involved folks. But it it is certainly a complicated issue, and I think you will hear very different opinions depending on who you ask. [Barbara Rachaelson ]: Thank you. And I'm gonna try to find my note from what meeting this was so I can follow-up with you. Thanks. [Chair Martin LaLonde ]: So so we probably will dive a little deeper into these issues. Why not till crossover? I and we don't have any bills that I'm aware of that are are seeking to expand, or look at a forensic facility or competency restoration. Though there's definitely interest in further exploring, you know, maybe setting something up for next year and having some additional testimonies. So that would probably be sometime in April, I'm predicting. But one of the things, you know, I at that time, we'd would like to get input again on where the administration is, on where the Department of Mental Health is on competency restoration. You know, we'll be asking, you know, state's attorneys as as well. But just to flag, I I had some questions I was gonna ask, but since we only have ten minutes before lunch, I'm not gonna go down that very complicated issue as well. So but anything else in general, you know, because we will be looking at this, like I say, it's pertinent of the kind of the introduction of the issue. So, yes, Angela. [Angela Arsenault ]: It's a very broad question and and not for right now, I guess, as what we're saying. But, I'm curious to to hear from your perspective about the, cooperation between, DMH and the judiciary. And I know that's something that, you know, there's been the, mental health in the [Michelle Childs ]: courts. Mission Symposium of the mental health. Yeah. [Angela Arsenault ]: And then every every year for the last two years now, a a coming together of interested parties. And so I'm just curious to hear, from your perspective how that collaboration works, is working, could work. [Michelle Childs ]: Yeah. [Chair Martin LaLonde ]: Probably another bigger issue to take up a little bit late later because we have to see where they intersect. Mhmm. So any parting words, though? We'll give you the last word. [Karen Barber ]: No. Not that I can think of. I'm always happy to come back and answer any questions you have or talk about different parts of our system. I will just note that, just so everyone kind of understands, the changes were made in statute. River Valley hasn't yet implemented these changes, so we are still actually not doing these things at River Valley, and that's for a couple different reasons. One, there are two rules that needed to be changed. [Chair Martin LaLonde ]: I got this really. [Karen Barber ]: And so rules [Chair Martin LaLonde ]: taken. Yeah. Yeah. [Karen Barber ]: Yeah. So that took a little bit. And then we need to train staff, and we also need to build a seclusion room. So that was in the original plans. You know, when we had first built River Valley, we asked for the ability to use EIPs. The policy decision at the time was no. So we we reuse that room for something else. And so now we need to go back and kinda rebuild the seclusion room. But we are anticipating that those things will go online maybe this summer. So [Chair Martin LaLonde ]: Okay. Great. Great. Thank you. Thank you. Yeah. Thank you for being here. That was very helpful. Katie, maybe we'll give you lunch for it too. [Michelle Childs ]: Oh, enjoy your lunch.

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SmartTranscript of House Judiciary - 2025-01-29 - 11:15 AM

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