Vermont Legislature SmartTranscripts:

[Speaker 0]: Good morning, everyone. It is Thursday, January 29, and today in the State House is Mental Health Advocacy Day. So we thought that we would bring in some representatives with various organizations so that they can tell us about themselves and what they do for the moms.

[Kathleen Kilbourne (NAMI Vermont representative)]: And first up, we have Kathleen Kilgore. Thank you, Kathleen, for being with us. Good morning. I appreciate your time and interest and the opportunity to share about NAMI Vermont, the National Alliance on Mental Illness of Vermont with you this morning. I'm actually going to share a testimony that was co created with Lori Emerson, our executive director, who's not able to be here in this exact seat today because she's just one building over for Mental Health Advocacy Day. These much of these were actually her words that I'm sharing today. But I will first start by introducing myself. My name is Kathleen Kilbourne. The things you should know about me is, for context, is that I'm an educator and a principal and was for twenty eight years in public schools in Vermont. So I bring that context to this conversation. I've been a foster parent, an adoptive mom and a bio mom, so youth is quite important to me. And lastly, and perhaps most relevant to this conversation, is I'm a suicide loss survivor. So in 2020, someone I love dearly took his own life. I'm working part time at the National Alliance on Mental Illness of Vermont, and I'm here representing that agency today. The testimony that I bring to you today is both personal and professional, as you might have expected from that introduction. But this mental health work is now really my why. It's shifted. It was education, and it continues to be education, but now education around mental health, or as we like to call it, brain health. We have heart health, we have lung health, we have brain health. And maybe if we called it brain health and not just mental health, that would help reduce some of that stigma and how we approach support and services. So Madam Chair and House Health Care Committee members, today is our eleventh year in bringing together over 40 co sponsors or 40 co sponsoring organizations and their networks for Mental Health Advocacy Day at the State House and the Vermont Supreme Court House Auditorium. We appreciate you inviting us to testify for your committee today. We'd like to do a special thank you, of course, to Representative Berbeco and Representative Cina for the resolution recognizing Mental Health Advocacy Day and for Representative Berbeco as one of our keynote speakers at our morning program. In the spirit of transparency, Daisy also sits on our board of directors for NAMI Vermont. So if you have more questions, she'd be happy to answer them, I'm sure. So who are we? Who's NAMI? NAMI Vermont is an independent state charter of the National Alliance on Mental Illness, which is a statewide nonprofit. It's a grassroot organization run heavily by volunteers, and it was incorporated in 1984. There are over 600 chapters of NAMI and affiliates throughout the country, it's not specific to New England or just Vermont. Our mission at NAMI Vermont is to support, educate and advocate so that all communities, families and individuals affected by mental health can really build better lives, even though they face some challenges. Our core competency is really valuing having lived experience as family members, caregivers, peers and individuals with mental health conditions. It's really a critical asset in creating safe spaces for conversations and questions and finding resources about mental health. Who do we serve? The community, family members, peers and individuals affected by mental health conditions and the professionals who work with them. A quick snapshot of statistics. In Vermont, mental illness affects approximately one in five adults and one in six youth age six to 17. That's one in five individuals. Nearly one in twenty adults are living with a serious mental health condition such as schizophrenia, major depression, bipolar disorder, for example. Despite these statistics, it's really important and critical to remember that most people with a mental illness can and do lead very fulfilling, productive lives with access to effective treatment and care, community and family supports, and good self care. So what do we do? From parenting classes to in person and remote support groups to presentations, staff and volunteers administer all of

[Unidentified committee member]: our

[Kathleen Kilbourne (NAMI Vermont representative)]: free programs that focus on education, support and advocacy. Those are our three pillars. My testimony today will focus specifically on community connections for youth and families. So NAMI Vermont is launching a new initiative called the Uplifting Youth Voice to Advocacy Program for mental health policy reform. It's designed to equip high school and college age students with skills and supports to become the next generation of mental health advocates. This effort strengthens youth influence and public policy by engaging young people directly and identifying and speaking up about what mental health issues that matter to them the most. We need more legislators to help with this initiative. Representative Berbeco and Rep. Zydin Boslaun have already confirmed their involvement. From January 2026, youth ages 14 and above can join our youth mental health advocacy cohort. They will receive advocacy training, practice sharing their testimony and meet with legislators and receive some ongoing coaching and mentorship. We're partnering with youth serving organizations to ensure safe, inclusive environments where young people can elevate their priorities and really help shape mental health policy in Vermont. To that end, today, I have been partnering with Job Corps in Virgin's, and they are here with a group of today for the first time in the statehouse. And so I welcome the opportunity not just for them to see and understand the process, but to become part of that conversation. We seek additional legislators who can mentor and coach youth advocates and listen to their testimony. If you'd like to be involved, please reach out to me directly or go to namivermont.org/youth. As we mentioned, we are a nonprofit, so all of our services are free to consumers. What that means is we don't need to know what your insurance is, and there are no financial barriers to access those supports or services. And we do that statewide, both remotely and in person. We are 100% funded by grants, sponsorships, donations, partnerships and volunteers. To that end, we must have an annual fundraiser. And to me, my title actually at NAMI is events and fundraising coordinating, although that's one piece of the role. I also volunteer to do other things like lead parenting classes, and I go into high schools and college campuses and teach a program called Ending the Silence, which is about, helping youth to understand it's okay to ask for help, how to access help, what is 988, is it really confidential, answer their questions. In that program, Ending the Silence, I go, with a youthful person with me, because while I can deliver content, statistics, support and resources, it's really important that they connect with someone closer to their own age. And we know that what that youth says in their fifteen minutes is gonna way outweigh what I say in my forty minute presentation. And so for street cred, we do that together with someone who is more youthful and who has lived experience to share. So that's ending the silence. But we are having a walk, the NAMI Walk that we have annually. This year, it is May 16, United Day of Hope. We would invite each and every one of you to come. You do have to register. It's free. There's not you don't have to fundraise to come. Yes, my job is to create enough financial support for these programs to continue. However, as a suicide loss survivor myself, the other half of that day for me is to create a safe space of community where people can come and bravely show up to be themselves and, do that without stigma or judgment present. We know the largest, there's many risk factors, but the largest protective factor that we know, both through practical application and research, is human connection and relationship. So that's really what that day is about. It's about allowing people to meet other people. We create at this walk what I'm calling a resource buffet, because who doesn't love a good buffet, right?

[Speaker 0]: You go around and pick

[Kathleen Kilbourne (NAMI Vermont representative)]: what you like. So the resource buffet will have over 40 vendors of nonprofits, and our walks and participants can go through and choose the supports that matter to them and their family at our resource buffet. We'll have a silent auction. There's two food trucks. There's a live band. It's a festival environment. It's a day of connection and fun. And hopefully, doing that, we raise funding for these programs to continue. But people can come and not fundraise at all and just enjoy the day. So I will leave you with information about that on this little card for save the date so that if you're not able to come, perhaps you are able to share this information. Because when people say, who does NAMI serve? I like to say human beings. We all have brain health. To that end, we also have a new grant through UVM, and we are doing some community conversations where we're gonna have three to four, panelists, professionals in the field, and those with lived experience, peers as well, who will create a safe space to have conversations and ask questions. These topics will range from Vermont authors, who write about mental health, because that's a bit of a softer entry and landing than perhaps some of the tougher topics to talk about. So if someone isn't yet ready to say, I'm looking for support and help, they might very well be willing to come to an author talk, right? So it's a soft entry point with intention. We also will have a conversation about the challenges in Vermont for LGBTQ folks and people in that community to access services. And certainly, they are under many more stressors than some of the other populations. We're having one group about postnatal care and postpartum, right? Something that doesn't get talked about a lot. So there's a variety of those community conversations that are up and coming. You can check our website. We also, lastly, I will just talk about basics class quickly. We teach a parenting class online. I'm one of two facilitators for that course. It's statewide because it's online free of charge, and allows parents to meet other parents who are also supporting their own children and their communities. And we give them some very basic structural information and hook them up to resources and help them know what questions to ask. And how do you navigate an IEP meeting? And how do you ask for help or get that fuel in your tank? We talk about basic needs. Then we talk about what they wanna talk about. Like, we have an agenda, but we also have space for them to just bring what's important to them in that moment and be a listening ear with some empathy and grace. So it's really important that begins in March. I am happy to answer questions, have conversation. I do want to respect the time. I know there's other speakers today, but I certainly am highly engaged in this topic and would be happy to talk individually or collectively after this if you have more questions or an idea for a project or want to talk to me about how to engage with NAMI Vermont. I'd like to just thank you for taking your time and interest to listen to my testimony today. What we do at NAMI Vermont Statewide is life changing, and it can really be lifesaving. We appreciate your continued support and collaboration to reach as many people as possible because we all have mental health. Thank you. Please visit namivermont.org for more information or connect with us directly. And I have just three small pieces of paper for you, a quick brochure of the programs of what we actually do and how to get in touch with us, a save the date card for that fun walk. I know that Daisy will be there, and we hope many of you join us for that day, a great day of human connection and relationship. And then I'll also just leave you my contact information. But I would, again, be happy to speak individually or collectively at any other time. Thank you for your time today, and I'm happy to answer any questions.

[Speaker 0]: Thank you. Go ahead, Copper.

[Unidentified committee member]: Thanks for coming in first.

[Kathleen Kilbourne (NAMI Vermont representative)]: It's my pleasure, thank you for the opportunity.

[Speaker 0]: I have a question. Do know

[Unidentified committee member]: if UVM is involved in any research or any studies concerning mental health causes, it's things like that.

[Kathleen Kilbourne (NAMI Vermont representative)]: I can't speak directly to research. I can tell you that we partner with UVM on a number of fronts, from helping to train their nursing students to working with their psychology department. We're currently working with Reba Porter, who also sits on our board of directors, who works at the hospital to bring the UVM connection to the hospital to actually have a support group in inpatient stay at UVM. That's in progress right now to get that group going. But in terms of the research, I honestly can't speak to that directly. I'd be happy to try to find out and get back to you.

[Unidentified committee member]: But my follow-up question was gonna be, tell us a little bit about what you're doing with UVM. You just did that.

[Kathleen Kilbourne (NAMI Vermont representative)]: Great, yeah, there's a number of ways. We go to many, guest lecture outside of this, I guest lecture at five universities in Vermont, both on education and mental health. So those relationships now have helped to introduce NAMI. And we go to college campuses and do that entering the silence. We also do a very short presentation, dissimilar to what you just had with a little more zest, and a PowerPoint about NAMI, so they know how to access our services. But we also do a program called In Our Own Voice, which allows someone who is deeply affected by mental health to tell their story in three parts on a college campus, which is what happened, what helps you, and what are you looking forward to? So it always ends on a note of hope and inspiration. It's someone who's already gone through their challenge and is really on the other side. I often partner, and I teach about NAMI, and then my friend Jody, who's a part time staff member at NAMI Vermont, who allows us to share her story openly. I'm not speaking out of turn. She's a published author. She writes about her experience, but she's also an incredible speaker. And she is someone who's affected by auditory hallucinations, meaning she hears voices all the time. But she's an author, a mom, or I should say aunt. She's an author, she's a mom, she's a friend, she's a colleague and an incredible speaker and writer. She writes beautiful poetry. And when she tells her story, it immediately breaks down some myths. You know, people say things like, Well, I can't tell from looking at you that you hear voices. Like, there's a lot of assumptions or stereotypes that in a twenty to thirty minute talk, Jody breaks those down pretty quickly for people. And she also graciously allows them to ask her questions that might be tricky or might be uncomfortable or not typical. And she answers them all with grace and vulnerability. So we're really fortunate to have her as part of our staff. So there are those presentations. So when we go to college campuses like UPM, we we often, do Ending the Silence in our own voice and about NAMI, sometimes off readings Mhmm. On a regular basis. But we're happy to go anywhere. We we just went to the Lions Club recently. Like, we'll you know, in services for teachers, we're really happy to go anywhere where there's an interest in having a safe conversation that's facilitated for people to learn about resources.

[Rep. Brian Cina (Member)]: Thank you.

[Speaker 0]: Thank you. Good work. Thank you, Houghton.

[Unidentified committee member]: A question. You said you're an educator at schools.

[Kathleen Kilbourne (NAMI Vermont representative)]: I am.

[Unidentified committee member]: I don't know how to present this question, but what would you like to see more in the mental health capacities for elementary and up? Or what are we missing in those schools?

[Kathleen Kilbourne (NAMI Vermont representative)]: That is like my dream question, and how much time do you have? So, as the principal of twenty eight years, I'd love it to just be part of the curriculum, starting very young, right? And so, we're not going to go into elementary schools and talk about suicide prevention, but we absolutely should be teaching part of health, not just nutrition and what you eat. We should be teaching brain health from day one. We should be teaching self regulation skills. And it should be part of the curriculum because these are the life skills people need to solve problems, right? And so it's applicable across the board. It's not just one content. It applies to every relationship you have from here forward. So I definitely think it should be available for everyone in a consistent, scaffolded, planned way with intention and purpose. And I also think sometimes best of intentions don't always land, outcome and impact sometimes don't match, right? So we say like, we have a high school guidance counselor, that is phenomenal. That's great. But you know what, in order to go see that high school guidance counselor, you have to miss a class, make up the work. It's not like, you're asking the student to make further accommodation to be brave enough to ask for a service that they need at a time that doesn't necessarily work for them, it's based on the adult schedule. Like, there's got to be better ways that they're not being penalized. We have to make it easier to access those services and more universal.

[Unidentified committee member]: Can I have a follow-up question? Please. When you say you're part of the curriculum path, what intent do you mean that?

[Kathleen Kilbourne (NAMI Vermont representative)]: I mean, we have PE class, where you work your body. We have health class, where you learn how to eat your vegetables. We need to incorporate into that health class, how do you take care of your brain? How do you self regulate? What do you do? We need to teach from day one that mental health is on a continuum. And you don't there are hard days and sunshine days, but like, you're not stuck there. You have the ability to self regulate and what helps. So even with young children, when they have, we just call them really big emotions. I taught first grade for eight of my years, right? I've had conversations with kids every day about, you know, they're throwing themselves on the floor, and my question is, Wow, you seem really upset. Did I get that right? Or I say, Hey, you seem really sad. Did I get that right? And they say, No, I'm not sad. I'm mad. Well, that's good for me to know because I'm going to react different. My response is going be different for sad or mad. So I think we have to teach educators how to ask the questions, but we also have to provide space and time and opportunity for kids to have direct instructions in things like self regulation. We figure out on our own as adults and maybe through our teens things that help us. If I asked right now, if you had a crap day, let's just pretend, not today, clearly, but put some day. When you went home, what would you do to help yourself feel better? Seriously, let's just take ten seconds. What would you do?

[Rep. Daisy Berbeco (Ranking Member)]: Text a friend.

[Kathleen Kilbourne (NAMI Vermont representative)]: Meditate. Text a friend.

[Unidentified committee member]: Yoga.

[Kathleen Kilbourne (NAMI Vermont representative)]: Yoga. Pet your dog. Listen to music. Go for a walk. Drink some water. I said water. Yeah? Same thing. Time and place. So I'm saying we have those skills. But what if we asked five year olds that same question? When you have a big feeling, what do you want to do with that? And then we record their answers, and then we leave it hanging in the classroom, and when someone's on the floor, we say to them, You and your friends came up with this great list. I want you to go pick two and try it and come back to me in a minute. You have to create time and space for those learning opportunities as they present themselves. You can't just teach it in a textbook and hope they put it in somewhere, like they apply it somewhere. With little people, they have to feel it, see it, touch it, do it. There has to be time for that. And the schedule for any public educator today will tell you it is crammed with stuff. And so mental health to me has got to be more of a priority and given time and resource in schools, because it's going to affect every relationship there forward.

[Speaker 0]: Appreciate that. Thank you. You just, I'm gonna have

[Rep. Daisy Berbeco (Ranking Member)]: to invite you in if we take off this bill H-eight 17, if we take it off the wall. It's introduced today, but it's all about mental health literacy in schools and everything that you just spoke to. I would

[Kathleen Kilbourne (NAMI Vermont representative)]: love to learn more about that or to have an opportunity to support that.

[Rep. Daisy Berbeco (Ranking Member)]: And also just thank you for everything that you do in your leadership at NAMI and for being here today. I appreciate the opportunity. Also, want to be sure to recognize my chair because she's the one that actually invited in all of our advocates. And I don't think another chair has really carved out as much time as this one has.

[Kathleen Kilbourne (NAMI Vermont representative)]: I appreciate lucky that. To have her. I think those lived experiences to bring a lot of power the power and information, you need data to make informed decisions. And so I just look at this as an opportunity to give you some more data to ponder and to reflect on and to ask your own questions about what's working well, where are the gaps, how can we help. And then it's really difficult to prioritize and they have a tough job ahead of you, but I'm happy to assist any way I can. And I appreciate the opportunity to share.

[Speaker 0]: Brian has a question, but just speaking of gaps here real quick, Center for Health and Learning recently Post.

[Kathleen Kilbourne (NAMI Vermont representative)]: In Transparency, I served as their executive director for a period of time And they

[Speaker 0]: were the nonprofit that sort of served suicide prevention. Yes. And as a suicide loss survivor myself, thought it was Thank you for

[Kathleen Kilbourne (NAMI Vermont representative)]: sharing and being vulnerable.

[Speaker 0]: I'm wondering if NAMI has sort of taken on any of the things that we had kind of tasked aside for help and learning with to hopefully close some of the gaps. Yes.

[Kathleen Kilbourne (NAMI Vermont representative)]: So again, I wanna stay in my lane. Lori Emerson is our executive director. She will be with us through June. She is leaving in June. She's retiring after fourteen years of leadership. Those will be big shoes to fill. And in doing so, in conjunction with that, we are creating a strategic plan right now and just beginning those conversations. The Vermont Suicide Prevention was obviously part of CHL and a big chunk of my area of expertise and work. And so I would very much like to see NAMI expand their work. I think it's gonna be I know it'll be a huge loss to not have CHL, and there are a lot of relationships in place that should continue. To that end, Vamhar was able to rehouse the You Matter curriculum, and they have that trademark. And I have met twice with Vamhar in the last week to have conversations about how are they updating that curriculum and how can I help to make sure that that curriculum continues because it's very strong? And I've trained it many times in many places, and I'd like to see it continue. And I told them I would be happy to do that as a NAMI affiliate or as just a human being who has interest in continuing to see that go. So whether it's with a NAMI hat on or a suicide prevention hat on, I think we have to be really intentional about that. And so some of that curriculum will land at Van Horn. I absolutely think there is a gap in need and that NAMI, with some preparation, could staff up given grant opportunities. Again, small nonprofit has to be funded. So I would love nothing more than to see an opportunity for suicide prevention to be rehomed or housed and allowed to expand across the state. It's an absolute it's a it's a need. It's life changing and lifesaving. Yeah. So I hope that that's the case. It is in discussion. We are definitely talking with Damhar. And then just from my lived experience, I I know how critical it is. And while we can have individual conversations on many places, it's really important to do that in an organized process way. And so I hope there is an opportunity for NAMI and other small nonprofits to do that work in coordination with our designated agencies. I do want to give credit to the designated agencies who are doing really creative things like urgent cares that you can walk into for mental health, right? In addition to the ER, the ER does everything they can. But I'm going to tell you as a consumer of service and someone who sits with people in the ER, it's not a therapeutic setting, right? If you are already under anxiety, that's not a great setting. And yet it saves lives, it's what we have. So this idea of community based walk in mental health, the one that Howard's doing, I know there's one in Middlebury with CSOC, I think is critical. And I'd like to see those expand as a way of access. So yeah, I think we have a lot of work to do. And absolutely, CHL and VTSP will leave a gap. And we need to be intentional about how are we going to fund and who's going to do that work. But there's an absolute need.

[Speaker 0]: Sorry to interrupt you, Brian. Brian has a question, but you said gaps and that I immediately thought talking you

[Rep. Brian Cina (Member)]: about making time and space in education system to teach humans as they develop emotional regulation skills. However, many humans miss that opportunity and now they work in places that are not good for their mental health. So I'm curious, like, if you have ideas about how we might better improve the working conditions for people to improve the mental health of our population and quality of life.

[Kathleen Kilbourne (NAMI Vermont representative)]: Excellent question. And yes, I would agree with everything you just said. And I think there's an absolute place for workplace wellness, right? We have to start where we are. So it's great if we can be preventative and help the youth do it another way now that we know, but we also have to start where we are. So I think that goes to NAMI partnering with businesses and other places to do in services and facilitations. And when Jodi comes in and talks about her mental health, when I say sometimes to a group of people, there's not many people that you places you go where you say, Hi, I'm Kathleen, I'm a suicide loss survivor. Like, that is not your lead. Do know what I mean? So we have to create safe spaces for those conversations. And I think that has to be at the top of businesses to create retreats, in services, staff meetings, and make it a priority to use the resources, free resources that are available, so that people can access help. I mean, when I go and talk in larger groups, I often ask raise your hand if you know what nine eighty eight is. Nine eighty eight has been around a long time, and we're getting less than half of the hands go up. We have work to do. Like schools are a little better, schools are a little higher. But when I go in the business world and say, what is nine eighty eight? And that's on us. If half the people don't know, that's not just on the people. That's on the human service field to continue to put it out, to market it, to make it accessible, to explain it, to take off the stigma, to We have work to do for sure. So workplace wellness, I think that should be in the strategic plan, 110%. And we really have a lot of work to do around stigma, right? Just really quickly, last quick story. When I present, I often help frame for people how big that stigma is. Let's pretend you were taking down your holiday lights, you fell off a ladder and you broke your arm. You would go to the where? ER. ER. ER.

[Rep. Daisy Berbeco (Ranking Member)]: Urgent care.

[Kathleen Kilbourne (NAMI Vermont representative)]: And what would they do? You go to urgent care or the ER. And what would they do? I hope not. My goodness. Let's not jump to conclusions. They would x-ray it, they would assess it, and they would see that it's broken. We're gonna pretend your arm is broken. And after assessing it and seeing that it's broken, they would put a cast on, which would support it temporarily while it healed. When you went to work on Monday, you would say, oh, you won't believe what happened. I felt the louder. Was taking down the lights. Blah blah blah. Broke my arm. And because people can see that you're in a time of temporary need with that cast, they would say to you, can I carry your coffee? Can I open that door? How can I help you? Because they can see it. Let's tell that same story again. I'm going to change just one factor. Instead of breaking your arm, this weekend, you had a this past weekend, you had a really difficult weekend emotionally. You lost someone you loved. You're under a lot of financial stress. You're not sure if your job's going to let you off. You had a really dark day and you went to the ER for some mental health support or maybe even a suicide screener? How many of you are gonna go into work and be and say, hey, Monday on Monday, hey. Went to work, and this weekend, I went to the ER for a suicide screen. Are you gonna share that, honestly?

[Rep. Brian Cina (Member)]: Talk about it, they're gonna be like, move on.

[Kathleen Kilbourne (NAMI Vermont representative)]: Well, listen. And why not? Why not? Why won't you share that at work? Stigma?

[Rep. Brian Cina (Member)]: You get judged.

[Kathleen Kilbourne (NAMI Vermont representative)]: Fear, judgment, seen as not confidence. You're afraid it'll change your work performance.

[Speaker 0]: People will treat differently in

[Kathleen Kilbourne (NAMI Vermont representative)]: the future. Future. So here's our job collectively. We have to make it as safe to talk about that cast and physical break on our arm, our physical health, as it is our mental health. That is the work ahead of us. Because really, it's quite similar. That same person who is having a difficult, dark weekend needs support. It needs an assessment, it needs support, and it's a temporary time of healing. They're not going to be in that place forever. It ebbs and flows. But we have to be able to have places that people can ask for what they need without that stigma and judgment. So that's our work at NAMI, and that's what we need your help with.

[Speaker 0]: Thank you so much, and thank you for your work.

[Kathleen Kilbourne (NAMI Vermont representative)]: Thank you. My pleasure. I'd love to just pass around those quick, if you don't mind, take one and pass it around. And I'll leave you my card.

[Speaker 0]: Happy to speak with any

[Kathleen Kilbourne (NAMI Vermont representative)]: of you. If you'd like us to come to your anything, your Lions Club, your circle of faith, we we have a project called Faith Work. We'll we'll FaithNet. We'll speak at churches. We'll speak anywhere anyone willing to listen.

[Unidentified committee member]: I've got daughter to the elementary setting for the summer years.

[Speaker 0]: Well, thank her for her. Thoughts about this all. Thank you.

[Rep. Brian Cina (Member)]: Don't address it. Thank you.

[Rep. Daisy Berbeco (Ranking Member)]: Thank you.

[Rep. Brian Cina (Member)]: Sasha, did you get the message?

[Speaker 0]: Did. Yeah, I had an email.

[Rep. Brian Cina (Member)]: You got with that?

[Speaker 0]: Sasha, I'm I'm taking hold for yourself. Our next guest is here. Is it Phoenix? Okay. I guess we're moving on. Alexander. Hi.

[Rep. Brian Cina (Member)]: I did get an email from someone saying they couldn't have access but I connected them with Tasha so let's see.

[Kathleen Kilbourne (NAMI Vermont representative)]: Other extras coming around the table, brochures or cards that I can take

[Speaker 0]: back? I

[Kathleen Kilbourne (NAMI Vermont representative)]: just stopped lots.

[Speaker 0]: I'm sorry, would you mind giving us one brief moment? Can you send that to me? Please. Before. Yes. We're pivoting. We're we've got our full attention.

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: Thank you, Madam Chair and committee members. And thank you for your presentation and for all the work that NAMI does. It's such an important part of advocacy and support of families and stigma busting in the communities. More about what's happening. I'm Alexander Smith, director of adult mental health services at the counseling service at Addison County, and people often refer to me as Sandy. I go by hehim pronouns. And I'm here to speak about the impact of the mental health urgent care initiatives, in particular, our program in Addison County called Interlude. And part of the timing of this right now is that Interlude's funding is uncertain after the end of the grant at the June. So we're here to in part advocate for that. And also, I think also just speak to what's happening in the urgent care programs. And I think a really important aspect of these programs that they're just very low barrier. And I think interlude some of the ways that we put this program together really exemplify that. In this next stretch through the legislative session and while we're here today, I think there's three main themes that we're gonna be advocating for. One is continued funding of Interlude beyond the end of the grant period. Two, that we do what we can to support a firehouse model of funding for these programs that we think is critical to their success so that as other crisis systems, you're paying for the capacity for people to be available, and then you're less reliant on billing and other procedures to bring in the revenue. And then three, for the Interlude project, it's almost entirely staffed by peer staff. All of the other urgent care programs have peer staffing as part of it. And we really have to keep thinking about how those roles can be fully supported and sustainable, given what we're asking people to do in this work and how much they put themselves into it. To give a little background, Interlude came out of a work group over a period of two years of family members, clients and staff. And we were really just trying to figure out, like, what can we do to impact the amount of involuntary hospitalizations happening, impact the experiences that were happening in emergency departments where it would be crowded and stressful and people could end up spending a fair amount of time waiting for a hospitalization. And we heard of funding opportunities eventually that came forward first from a federal earmark supported by the Sanders administration. And we were one of the groups that that got started with that earmark. And then the legislature supported, a grant process that's facilitated by the Department of Mental Health that was our continued source of of funding. The model that our work group came up with was to offer alternative crisis support on weekdays, offering a welcoming and comfortable space based on the concept of this model called the living room model. The staff would work from this approach called intentional peer support, which is kind of a core practice in the Vermont system of care. And we also brought in the influences of another practice we've been working with at CSAC for the last fourteen years or so called Open Dialogue, which is more of a clinically developed practice, but very similar to intentional peer support. And, what's really important about this is instead of greeting people with a lot of forms and pre populated assessment questions, our staff would just prioritize meeting people, welcoming them into the space, taking time to hear, you know, what's going on, what brings you in, and really, you know, sorting out with them, like, what's what's gonna be supportive to you right now? And while all of the urgent care programs in Vermont include peer support, Interlude is unique in that it's the only program that doesn't co locate clinical services in the actual space. But we quickly refer people to other more traditionally organized services if that's what they're feeling they need. And the staff focus on listening intently, offering mutuality, letting people define what they need, and giving things some time, which almost always allows, you know, whatever distress just to ease enough for things to seem more manageable. In terms of results, I have to say, I mean, I've been working in the Vermont System of Care for over forty years and what we're seeing with the kind of engagement and connection that's happening so readily, so easily and interlude to something that just really stands out to me. Through the calendar years of 2024 and 2025, Interlude has met with a 143 people with mental health crises through about 1,200 encounters. Not included in these is another 15 to 20 open dialogue network processes that interlude staff have assisted with off-site. And these numbers are smaller than other urgent care programs. But when you kind of calibrate that to the population region we're serving, you know, they compare pretty well. And for Addison County, we think this is a very significant impact. People have come in coping with mental health crises of all types and levels of acuity. Interlude has had notable efficacy with people who really have some weariness, distrust of mental health services. And this you know, we're really seeing a very different dynamic with with a sense of approachability for folks who otherwise aren't finding their way into care. Since the start of the program in 2023, only one guest has gone over to the emergency department, and that was something they had just decided they needed to do. There have been some situations where Interlude staff have assisted people coming out of the emergency department and then averting a hospitalization altogether. Guests have shared that Interlude literally has saved their lives. Some have commented on the sense of safety and trust they quickly experience after they walk in the door and how differences how different this feels from when they have tried to seek mental health support in the past. Some have expressed that they feel they can speak to things that otherwise they fear would get them locked up. Others have commented on the experience of talking to people who get it, who have been through similar challenges with mental health conditions as well as adverse experiences in some service systems. One person who had come from come while in crisis and also coping with the extreme life stressors of being unhoused and without work, came back after many months of no contact, saying they're now housed, employed, feeling good about life, and they just wanted to thank the staff and see where this path had all started. For some people, this has been their first point of engagement and services. There are others who have a broader range of mental health involvement who have added interlude into their range of options for how to get support when when times get hard. The staff sometimes go off-site to offer support in other settings, including the emergency department. And when circumstances allow, they also participate in open dialogue network meetings with guests in their personal networks in an effort to collaboratively understand and plan for how to get through the crisis at hand. And this way of meeting in times of mental health crisis is also an area that we've just seen really remarkable results. So another data point that I wanna note is that CSAC has been running at a population adjusted rate of involuntary admission that runs well below the state average and, like, a half to a third. And we think that Interlude's played an important role in these results. And we're also experiencing something that we've heard from other peer led crisis supports, which is we haven't seen aggressive reactions in this environment, and and we hear this from other peer run centers. And we think it's the the difference in relational dynamics that the people are being met on a eye to eye level dynamic and also the lack of institutional cues in the environment.

[Speaker 0]: Can I ask a clarifying question? I'm intrigued by something you just and I want to make sure I'm understanding. CSAC has a lower service population than, say, other designated agencies in relation to the population of Addison Counties that and and is is there a correlation between interlude and this? I mean, you noticed

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: The lower admission Are you asking about the involuntary admission rates?

[Speaker 0]: Okay. I wanted to Yeah. I I wasn't clear that so we're talking about involuntary admissions.

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: Yeah. Okay. But we're also a smaller agency in smaller county and I think the numbers has been one of the issues around kind of longer term funding for Inner Lueders. So, for our population base, we think we're doing pretty well.

[Speaker 0]: Has that number been going down since how long has Inter moved in there now?

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: It's been running I mean, we had a soft start in the 2023, but it's been running full tilt for the last two years. I'd say we've diverted some admissions and some involuntary situations for sure. And, you know, I don't know that it's a direct kind of linear because our numbers were already low from the things we've been working on. But it's definitely helped sustain the dynamic of finding other ways to engage with people and head off something that has more impact.

[Speaker 0]: Thank you. I didn't mean to interrupt, but I wanted to clarify that, because that's really important.

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: Yeah, no, thank you. How are we for time?

[Speaker 0]: Oh, we're I think we're good. Okay. Oh, yeah, okay. So another couple minutes.

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: Okay. So I guess just to emphasize the role of peer support as a key part of this, the atmospherics of a space that is decidedly like the opposite of the experience of being in a stressful, busy emergency room, that this is a comfortable welcoming space that people would want to go towards in the times of distress rather than if you think about what an ED is like, that's a hard space to be in if struggling with other things internally. And then the very low barrier availability, which I think is really critical for the funding models for the urgent care programs, we just make it as easy and approachable as possible. And for Interlude, we have a number of people who have participated anonymously. And that, to me, tells me that there these are people who wouldn't be getting in somewhere else or they wouldn't you know, if we hit them with some billing forms and intake forms, I don't think that would have gone very far. And so I I think this is one of the the most important points about if if we can find ways to support these programs going forward to really try to fund it in that way. I think those are the main points. Think in terms of impact, one of the toughest issues in our system of care is when people really seem to need treatment and yet aren't finding their way to choose treatment. That can be really impactful on families. It's a big stressor and worry for our treatment teams and crisis responders. It can be impactful in communities. So anything we can do to make these programs as approachable, to make services help as approachable and safe, feel safe and comfortable for people to approach, I think it's really important that we keep developing that edge in our system of care. I'll stop there and see if there are any comments or questions.

[Speaker 0]: Leslie, could you share your testimony so that we could review it?

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: I did submit a written I'm report for

[Kathleen Kilbourne (NAMI Vermont representative)]: happy to submit it. Some of it is off script, so yes, the first part. Whatever you you have. In the moment.

[Speaker 0]: Yeah, thank you. And we know how vital this resource is because we know that our agency of human services is looking to expand with the rural health transformation in ensuring that all communities have mental health urgent care.

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: It could also help us bridge a year

[Unidentified committee member]: of funding, that would be fabulous. I

[Speaker 0]: was going to ask you if you would be able to expand your hours if you had increased.

[Alexander "Sandy" Smith (Director of Adult Mental Health Services, CSAC)]: We would love to. Our first worry right now is continuing beyond June. But if there was more to build on, we've we've started experimenting with Saturday hours and shifting back our weekdays, and we were getting some good responses on Saturdays. So, you know, there's much more we could do if we had had the means to do it.

[Speaker 0]: Thank you. Thank you very much. That's an interesting question.

[Kathleen Kilbourne (NAMI Vermont representative)]: I just want to say, Anshur Abdul and our both experiences highly valuable as someone who sits with someone who's in crisis in the moment. It makes such a difference. I just want to back up everything. I didn't know that someone

[Speaker 0]: was speaking after me when

[Kathleen Kilbourne (NAMI Vermont representative)]: I spoke previously, but one hundred and ten percent needed and the way to go. Thank

[Speaker 0]: you. We have somebody else joining us on Zoom. Tyler?

[Tyler Sears (Valley Vista client; person in recovery)]: Hi, how are doing?

[Speaker 0]: Hi Tyler, how are you?

[Tyler Sears (Valley Vista client; person in recovery)]: I'm good.

[Speaker 0]: Can you just introduce yourself? Introduce yourself to us?

[Tyler Sears (Valley Vista client; person in recovery)]: I'm Tyler Sears. Tyler Sears. I got a history of substance abuse. I'm currently at the Regen's location of Valley Vista. I wrote something I'll read to you guys. My name is Tyler Sears. I'm 35 years old from Burlington, Vermont, a recovering addict with over ninety days clean now. I've spent over half my life in jails, rehabs, and institutions no longer. I'm addicted to substances. I've managed sobriety a couple times in my life, but nothing like this most recent time with it. I was locked up in October for a series of misdemeanors stemming from substance abuse, unlawful trespassing to City Hall Park, and retail theft. When I was locked up, I had a prior authorized prescription for Suboxone, but didn't see my medication for eleven days. And even then, it was only gradually increased from two milligrams, not the twenty four hours prescribed. When I was inside the jail, the officers responded to self harm incidents, managing psychosis, and staying trying to deescalate crisis despite not being mental health clinicians. Inmates with serious mental health problems are being managed, not treated in remote prisons. Prisons are being asked to solve problems they were never designed for and then blaming the very people we're supposed to be trying to rehabilitate by saying they don't try enough or their behavioral problems are too bunched. People like me are told that this is an excuse, not that it's because we have a chronic, sorry, chronic relapsing condition that involves the compulsion to use and the, in a lifetime of mental health challenges. You're taking very highly traumatized people, putting them in a further traumatic environment, asking them to behave perfectly, and most are nonviolent, non listed offenders. I've talked to many people high on the totem pole of rehabilitation. We all share the same thoughts with DOC saying that they're gonna start offering substance abuse treatment. Their idea of this has been on an app or a tablet, not something taught in a classroom by an actual clinician. If the clinician was to be brought in there, the only way it would work is to have these inmates housed in a specific unit away from general population. Misery loves company, and the inmates there are not focused on recovery, would do anything possible to throw the other inmates off. I was there. I know how it works. I know it doesn't. If money's spent anywhere, it should be reintegration back into the community, transportation, and getting people set up for treatment and community resources. I was blessed to have left jail and went to Bradford, Zaun Vista for thirty ish days before coming here to Virgin's. Bradford was a great residential treatment where it got the necessary thirty days that it takes for the brain thinking that it needs the drug and to learn new coping strategies. It was through Valley Vista that I met Kevin Hammill, vice president of clinical and medical. The opposite of addiction is connection. Jess Kirby, my substance abuse counselor, not only drove me to Valley Vista, but connected with me the whole time I was locked up. And Vermonters criminal justice reform where she works has been there with me throughout the worst days of me getting high and a big part of my recovery as well. Having someone there for me when I was released made all the difference just alleviated the stress of court and getting sentenced. I believe along with many others that the answer lies in the data of the 3.1 program of regens. Treatment and evidence based, sorry. Treatment evidence based at that while finding the valley vista would open 3.1 beds and even allow resident residents of Bradford up to ninety days instead of twenty. It takes longer than twenty days to fully stop wanting drugs as a way to comfort and relieve stress. It's also known to take the brain ninety days to a year to begin rewiring its reward system through extensive treatment. I know this from personal experience that addiction is a trauma response in a way of coping with underlying issues, the only way that we're taught to work. So that obviously means that if an addict is taught better ways of coping, that relieves stress and reduce cravings on top of being connected with a support system to benefit their specific treatment and therapy geared towards the underlying issues they were using to self medicate to begin with, That means they have more of a likelihood of remaining sober than incarceration. Recovery requires hope, continuity and agency and jail takes away all three. I took the time to this 3.1 to write a book called But I Stayed outlining all of this and giving myself purpose another staple in finding recovery. Vermont needs the money invested into 3.1 residential treatment programs, not jail with a lack of coordinated entry where people are having their tolerances of substance lowered and then thrown back into the street, no aftercare plan, and drugs that are strong enough to kill people now. The first two weeks after release is the highest risk for this to happen. If if lowering the add addiction rate is the goal, it starts with stabilizing people, not just long enough to release them from jail into the same drug infested environment they've come from without any counseling under their belt or trauma based therapy. Instead, they leave jail with a release without release planning, inadequate dosing, or forced changes in medication. On top of that, incarceration also worsens trauma and anxiety, and especially for the ones that are already unstable. Cycling through jail disrupts housing and employment, family reunification, continuity of care, and they are released in the worst positions in when they arrive. It's not lowering the chance of relapse or giving the necessary treatment to save the situations that end in substance abuse. The change can start here with you expanding treatment, not incarceration, putting a cap on the amount of people or amount of time someone spends in jail before being admitted to treatment. And in that time, having them screened while they're drying out in jail and then admitted. It's not and not and by guaranteeing MAT uninterrupted in jail while substance abuse treatment is being set up with a strong aftercare plan in place and being inducted into the or and being induced within the twenty four to forty eight window, that hasn't been taking place. We don't have take into account how easily people are incarcerated, and it affects on their mental health, self esteem, and substance abuse. That's a very big setback that typically takes place after a minor infraction. It's a big reason some people struggle with substances so badly. I hope that we can move away from incarceration for people with substance abuse and instead invest in programs like Valvista and VCJR who are supportive every step of the way from overdose to jail, the long term recovery, and everything in between. Thank you.

[Speaker 0]: Thank you so much, Tyler. And I'm

[Tyler Sears (Valley Vista client; person in recovery)]: I appreciate the opportunity.

[Speaker 0]: Grateful that you're finding the supports that that you've been seeking.

[Rep. Brian Cina (Member)]: Appreciate it.

[Speaker 0]: Do you have a question?

[Rep. Brian Cina (Member)]: Can we ask you some questions?

[Tyler Sears (Valley Vista client; person in recovery)]: Yeah. No

[Rep. Brian Cina (Member)]: problem. So I'm Brian from Burlington, I'm wondering if you could say a little more. You said VCJR. I know what that is. I don't know if everyone here does. Could you say more about what that acronym means, and what are some of the specific things that are working well for you right now through that program?

[Tyler Sears (Valley Vista client; person in recovery)]: So VCJR is Remoders for Criminal Justice Reform. It's in the downtown area of Burlington on Bank Street. They do substance abuse counseling. They set up all your meetings, get you, like, reintegrated back in the community. One on one counseling. They do UAs. They report back to the court or whatever, like, probation, whatever you're in. If you're in jail, they'll take phone calls from you. They'll set up your treatment from there. They'll get you to rehab. They set up rides. They really do, like, basically, everything.

[Rep. Brian Cina (Member)]: You are you doing this are you are they doing contingency management with you at all? Or Yeah. Can you explain to the committee what that is?

[Tyler Sears (Valley Vista client; person in recovery)]: Now, I'm in Valley Vista, so I'm like the only thing I get from there right now is counseling and, like Okay. Over the phone, like Zoom or telephone calls.

[Rep. Brian Cina (Member)]: Okay. So it's it's counseling you're getting then. Okay.

[Tyler Sears (Valley Vista client; person in recovery)]: Substance abuse counseling.

[Rep. Brian Cina (Member)]: Yeah, the other question I had was, you were talking a lot about how when people are incarcerated, it makes things worse, not better. And can you say more about the harm that occurs to a person when they when they're put into incarceration?

[Tyler Sears (Valley Vista client; person in recovery)]: Well, in my in my case, like, it helped me for a second. Like, I don't believe that, like, long term jail is, like, the answer for substance abuse. A minute away from the drugs is the only thing that benefits. But so if that minute is taken in getting people treatment and you know what I mean? Yeah. It's great. But if you're ripping people away from families for a sensitive period of time, like, that first week and a half, you're in jail. You don't even really get a phone call. Like, you don't get to touch base with your family. It takes, like, a week and a half for you to get a pin sheet in where you're allowed to, like, have, like a loud people on a a list to call. And that does somebody's mental health. Like you it I don't know. It just breaks you from society. Like we're trying to teach people to reintegrate and like like be able to be out there in the community and putting them in a hole or putting them in jail. It's, like, the exact opposite.

[Rep. Brian Cina (Member)]: So it sounds like what you're saying is it's Get around people that have

[Tyler Sears (Valley Vista client; person in recovery)]: Great. Go ahead.

[Rep. Brian Cina (Member)]: There was a glitch and I thought you were done and I didn't mean to interrupt you. Sounded like

[Tyler Sears (Valley Vista client; person in recovery)]: Go ahead, ahead. Ask what you're asking, go ahead.

[Rep. Brian Cina (Member)]: It sounded like what you're saying is it's helpful to have people step in and interrupt the cycle of addiction, but it's not helpful to then isolate people. Sometimes it's necessary.

[Tyler Sears (Valley Vista client; person in recovery)]: Right. You know, it's it's not helpful to isolate, but, like, people ain't, like, my sense, the only way that I was gonna stop was to be ripped away from the drugs. So, whether I looked like treatment or jail, do I think that months in jail is the answer? No, but maybe a two week period where, like, people can get to work on treatment and, like, the aftercare plan, because that, like, really, that's the definitive thing. You could take somebody away from drugs, but drugs are always going be a part of the world. It's the aftercare plan. It's the, like, the process of, alright, what are you gonna do after you stop doing drugs? That's, like, the biggest part. Like, you need, like, it's, a step by step thing to follow. Like, oh, if somebody comes up to me with drugs or asks me if I'm gonna use, this is what I'm gonna do. Or if I find myself in a situation where there's drugs around or people who think like that, this is what I'm gonna do. This is who I'm gonna connect with when I have cravings. This is who I'm gonna connect with to get my probation, and this is not in hand. You know? Like, it's the planning that's really the biggest part.

[Speaker 0]: Thank you. Thank you for joining us today. Really appreciate it, sharing your experience. We're gonna take about a two minute break just to change the room over. And we'll be back. Thank you so much. And thank you to everyone who joined us today. We really appreciate it. We're going to actually continue this later this afternoon. Thank you.