Vermont Legislature SmartTranscripts:

[Rep. Alyssa Black (Chair)]: Welcome back everyone. We are moving on. Today is Disability Advocacy Day in the State House, so we've invited some people in. Is everyone testifying together, separately, one after another? I'll invite Mila. Okay. Hi. Hi. Welcome. Thank you. Just introduce yourself for the record.

[Nayla Reminski (Mad Freedom Advocates)]: Good morning. Thank you for the opportunity to testify today. My name is Nayla Reminski, and I work with Mad Freedom Advocates. This is an organization working to advance the rights of psychiatric survivors, mad people, and others marginalized by the mental health system. Through peer support, public education and legislative advocacy, we work to improve people's immediate conditions while building collective power and community based alternatives to coercive systems. At Mad Freedom Advocates, I work as a patient representative, supporting people who are involuntarily institutionalized to understand their rights, write grievances when necessary, and participate meaningfully in decisions about their care. I'm also part of our advocacy and education team, where we focus on leadership development, policy change, and organizing to expand dignity, choice, and autonomy. Most importantly, I come to this work as a person with lived experience. As a teenager, I was involuntarily institutionalized for two and a half years, where I experienced improper restraints, forced silence, conversion therapy and other daily abuses. This was punishment masquerading as care, punishment for needing more support. I do this work to help ensure that others are not subjected to the same treatment and are instead able to access support on their own terms when and how they choose. This is my story, but it is not unique. And there are many people here in Vermont with lived experience of harm by the mental health system. We deserve a voice at the table and a voice in each and every policy that affects us, policies made in this room. Too often people with lived experience are invited to participate only as storytellers or symbolic representatives. We believe that lived experience must actively guide policy conversations and legislative decision making. For instance, there is currently a bill H764 to create a working group around inpatient capacity that only requires one person with lived experience. This is unacceptable. People who will be impacted most by legislation should have their voices most centered and heard. I was invited here by Disability Rights Vermont to speak as part of Disability Advocacy Day twenty twenty six, and through my role on the PAMI Advisory Council, which advises Disability Rights Vermont on protecting the rights of people with mental health challenges. While some people strongly identify with the term psychiatric disability and claim disability as a political and legal identity, others experience or are perceived to experience mental health challenges or extreme states that do not see themselves as having a disability. But regardless of how we identify state disability policy profoundly impacts our community. For example, anyone in a locked facility voluntarily or involuntarily is considered a vulnerable adult and falls under the protection of Disability Rights Vermont and the Americans with Disabilities Act. People experiencing mental health crises are routinely locked in facilities in the name of care and denied the same rights to bodily autonomy and self determination afforded to others. Whether or not we claim the label of disability, we are often faced with the same challenges of being treated as incapable by the state and the state's policies around support and treatment. Mad Freedom Advocates has been working in coalition with Disability Rights Vermont on community screenings of the film Forgotten Promises, including one being held here tonight, which documents ongoing failure to uphold the Supreme Court's Olmstead decision. Olmstead affirmed that people have the right to receive services in the most community integrated setting appropriate, and that unnecessary institutionalization constitutes discrimination. MAD Liberation and Disability Rights Movements share a common fight, resisting unnecessary institutionalization and demanding real community based options. Olmstead gives us a shared legal framework for that fight. We all have the right to be free from segregation or isolation, yet this promise remains unfulfilled for many people experiencing mental health crises. Mad Freedom Advocates is tracking multiple bills in the Committee on Healthcare this session to ensure that autonomy and survivor defined safety are not sidelined in mental health policy. Age eight seventeen, eight eighteen, two twenty seven, age 61 and age eight sixteen relate to person centered mental health care and addressing issues upstream. Age five seventy three, seven twenty four and seven sixty four relate to institutional responses once someone is already in crisis. I appreciate that this committee is considering many mental health related bills this session. We are living through profound political upheaval, and people clearly need care and support. But how we respond matters. Just any mental health legislation won't protect our people. It needs to be rooted in autonomy and a version of safety defined by our community, not just those with power and voice. In my own life and in my work inside Vermont institutions, I see people stripped of rights and dignity in the name of treatment. These harms cannot be resolved simply by expanding or refining the same systems that produce them. We must think beyond institutional responses this session. Since the last legislative session, recent devastating losses underscore both the urgency of change and the real human cost of our policy choices. I'm a survivor of harm inflicted by our systems, and I'm here today to talk to you about it. But other valued members in my community are not able to hear it because of how badly these systems failed them. This past July, Scott Garvey was killed by Vermont State Police in his own home during a mental health crisis after he himself reached out for help. Instead of receiving care, human connection, or de escalation, his distress was met with armed force. His death is a devastating reminder that when crisis response defaults to policing and institutional control, seeking help can actually increase the risk of harm. We need options for support that don't compromise our rights or our dignity. This reflects a profound failure of the state to provide community based services as required under the Olmstead decision. The death of Middlebury student Leah Smith in October was widely framed as caused by mental illness, a narrative that obscured the pervasive transphobia, harassment and systemic discrimination that she endured. When we reduce such losses to individual pathology, we erase the social conditions that drive distress and we avoid examining whether our systems are truly providing safety, dignity, and community based support. Olmstead's not only about keeping people from being unnecessarily institutionalized, it's about providing real viable options to have their needs met while living in the community. Taken together, these deaths show us that Vermont cannot meet its Olmstead obligations by expanding inpatient beds, relying on law enforcement as first responders, or investing primarily in high level institutional care. Preventing future harm requires policy choices that prioritize community based peer led voluntary support, reduce reliance on coercion and policing, and address the social conditions that shape mental health outcomes. Instead of trying the same tried policies over and over, I want this committee to reimagine what's possible outside of institutionalization. I wanna highlight two bills that move Vermont closer to meeting its Olmstead obligations by investing in voluntary community based alternatives. H227 sponsored by representative Boslin, which expands peer respite services is critical because peer respites offer voluntary nonclinical spaces where people can receive support without fear of involuntary commitment or forced treatment. Peer respites are especially effective for people who avoid traditional systems due to prior harm. Research and lived experience show that these programs reduce hospitalizations, lower costs and increase trust and connection, key factors in long term well-being. Rosewood Cottage and Alyssa have been vital resources to our community already. The other one is H17 sponsored by representative Berbeco, particularly its mental health peer to peer pilot program, which represents an important move away from surveillance based or punitive approaches to youth mental health. By providing young people with information, peer connection and support early on, this bill promotes autonomy and prevention rather than crisis response. It treats young people as capable decision makers and helps reduce the likelihood that they will later encounter coercive systems. We've seen the power of peer support in Vermont already through the Pathways Warm Line, the Mental Health Urgent Care Peer Services, Soteria House and the Peer Respits previously mentioned. I hope what I've shared today might shift how you evaluate mental health legislation. And I will be back with my peers, my community members and my friends with important perspectives, including those who hold marginalized identities that I do not, whose voice deserves space in this process. We are not only here to testify in opposition or support, but to help think through legislation early before harm is baked into the policy. We welcome the opportunity to run bills by lived experience advocates who understand how these policies play out in real people's lives. In closing, I urge this committee to resist expanding inpatient and high level institutional care and fully investing in alternatives that center autonomy, choice and dignity. I'm grateful to begin this conversation today, and I hope to return to testify further as bills move forward so that we can work together to ensure Vermont's mental health policies truly support people before, during, after they reach crisis. Thank you for your time, your attention, and your willingness to consider new possibilities.

[Rep. Alyssa Black (Chair)]: Thank Thank you. I'm gonna ask that we hold questions only because we have two other people to get through, but it has to be done by noon. If she could submit her, that would be great. Can you submit your We really appreciate you coming in. Next

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: up, Sarah. So Sarah is actually not a historian, especially in front of Senate Health and Welfare. So there was a conflict between her schedule. I'm Lindsay St. Moore. Lindsay, if you do have questions for me, Ila, I've been before the committee before. I would love for you to be able to do that now. That is

[Rep. Alyssa Black (Chair)]: how about we start we go to you. Okay. And then if we have time, we'll do Neela and

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: I can field questions together. And I am, full disclosure, a little bit scattered, but I'm here.

[Rep. Brian Cina (Member)]: We have your written testimony at CES. Fantastic.

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: All right. So I am Lindsay St. Moore. I'm the executive director at Disability Rights Vermont. I've been with the organization for about thirteen years. I am an attorney. And prior to being the executive director, I was staff attorney. I did a lot of outreach in inpatient psychiatric facilities, correctional facilities, and all sorts of things. For those of you who are not familiar with Disability Rights Vermont, we're the protection and advocacy for the entire state. Every state and territory has a P and A. We are 90% federally funded to investigate serious rights violations, abuse, neglect, alongside with our federal access authority. So unlike a lot of other organizations, we really do have the ability to kind of get access to information and people in all different types of treatment settings to make sure that rights are protected and enforced. We are also the mental health care ombudsman for this state. So we have another layer of oversight for folks that are in the custody or temporary custody of the Department of Mental Health for folks receiving inpatient or involuntary inpatient treatment in psychiatric facilities. I also serve as the vice president of the Vermont Coalition for Disability Rights, which is why we are here today, Disability Advocacy Day. In the past, the last few years at least, we've been calling it Disability Awareness Day. We wanted to move away from that because it's not about awareness anymore. That's not really enough. We really want everyone to be encouraged and empowered to advocate for what their needs are and for what their rights are and what their hopes and opportunities are. It's no longer about survival, but really trying to make sure that people, that there's some enjoyment at the end of the day, not just survival. So that's been my goal in my role as the executive director is really trying to move the needle on this survival mentality and not having to fight for just our basic needs, but really for opportunities that will help us just feel better in our communities and feel meaningful and included. Like I said, I'm scatterbrained because we just did their press conference in the Cedar Creek Room. Too many bones. I'm gonna call it my testimony. I was looking at my testimony actually from March 2024 before this committee. And it could be the same today. There really is an overreliance in our opinion and what

[Rep. Alyssa Black (Chair)]: we

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: see from people with lived experience on forcing people into institutional care. I don't think that comes from a place of malintent or misintent. It's just, I think it's a sense of urgency to help people fix what ails them and what they're going through without really centering the person first. And I see it in my own family. I have family with lived experience and there are certain family members who think the best place is just to put them in the hospital, get them into an inpatient psychiatric bed because that's what they need. But when you talk to that family member or that person, they could have used help much earlier on to not be in that position, to get support in the community. There's an inequitable investment in community based resources versus institutional care. It's not very fiscally responsible. I know this isn't appropriations, but when you're talking about the cost of putting somebody in an inpatient psychiatric unit versus trying to serve that person in the community with their friends, with their family around them, with job opportunities, whatever the case may be, you are going to be able to serve so many more people the right way if you invest earlier on. And something that Disability Rights Vermont has been really wanting to see more of is when the Department of Mental Health, in particular, comes before different committees and says, we want to create this type of facility. We need this. We need to make this happen because there's a handful of people that need that level of care. DRVT wants every committee to question that and say, well, what have you tried instead of that? What have you invested in? And if there really is that small need, there needs to be an equally, if not more investment, in a community based alternative. Because when we're trying to fix things at the most restrictive level of care, it's costly, and we're missing the mark. I think if anybody said what the utopia is, it's not that there's an emergency department that can warehouse folks when they're in crisis. It's that the crisis was prevented in the first place. So we really have to start investing at the ground floor at the foundation. There's a lot of talk about paying direct care providers more appropriately. That's where the valuable work is, caring for people, serving others, and making sure that people are well taken care of and have opportunities. That is the most valuable thing. You can go work at a fast food restaurant and make more than you can make than caring for your community members. And that is just wrong. And it shouldn't be the Vermont way of doing things. We really should be putting our money where our values are, and that is in providing direct services to people. So once we've fixed that problem and it is something to be proud of to work in the direct service field to provide mental health support, I think you're going to see a lot of the need at these higher levels eliminated. So we need to slow down the track of we need a forensic facility. We need another adolescent inpatient unit. My ears just burn when I hear that thought come up because we're considering warehousing and locking up our children rather than investing in our schools and supporting them where they need it, where we can prevent that harm that comes from being institutionalized. Not saying that there isn't a need for some degree of beds. But before we consider adding more beds into a system, we need to be investing in the community. Because if you go to each of those different inpatient facilities that we already have, there are many people there who are stuck there. It's not that there's a lack of other beds. It's because there are people there. And we've seen people who have been there for years. One individual was in one place for a couple of years because they were a fall risk. And the step down facility didn't have a 1st Floor apartment for them. So for two years, we couldn't come up with a solution at the state level to put that person in a 1st Floor apartment. And eventually, that individual deteriorated and needed an acute level of care because they were so hopeless by being stuck in the institution. Emergency departments also see a lot of folks being stuck in emergency departments because those beds are being taken up by folks who could be in their communities. So I think that's really I know that Nayila mentioned Olmstead. That is something that we're very, very passionate about seeing implemented and enforced. The Human Rights Commission did a Holding the Line report. I'm not sure if this committee was able to read it, had some recommendations. Some was about investing in the workforce and paying people more appropriately. And the Olmstead decision was also in there and maybe revitalizing an Olmstead commission. When that decision first came out, Vermont did establish an Olmstead commission and it said, let's do like, let's take the pulse on what are all the different services that we have in the system? What are the different gaps? And unfortunately, back when that legislation passed, it also sunsetted it. So it said, write this report and then this law is going to go away. So came up with this robust report. It's like 116 pages. And then identified all the different services, all the different gaps, all the different needs. And then it went nowhere. And so one of the proposals from the Human Rights Commission was to bring that back and build in some enforcement or some accountability so that we're not in this wheel of saying the same thing over and over, but we really start to make some headway on giving people what they deserve, which is access to services and support when they need it, where they need it in their community. And I don't usually like to just talk like that, but I think I had too much coffee today. So I'm going to stop there. That way we have time for questions.

[Rep. Brian Cina (Member)]: I have questions for both of you, Wayan. So I'm hearing very strongly a common message, which we've heard in my whole time in the legislature, which is that the government often invests too much in the most restrictive institutional options at the failure of supporting the community properly, which then sets up a situation where we feed people there, but then we also hear the other side of it, which is that there's always going to be people whose behavior, whether it's related to mental health conditions or otherwise, gets them justice involved, and then what do we do? And there's many people who are justice involved who languish in prison cells without getting help or without getting treatment too. So this is what the argument for the forensic piece that we hear often is like, what do we do about the people who aren't fit to stand trial? How do we help them recover so that they can have due process, etcetera? So I want to acknowledge I'm hearing strong advocacy against institutionalization, but in the face of this remaining unsolved problem, I'm hoping we can work together on some kind of solutions for the higher end without taking away from the community. Because we can do both, it doesn't have to be we build giant hospitals and not house people. Why is that always the position we're put in? We should be housing people and then coming up with creative solutions for when a person is unsafe in the community. So what I would like for future reference, unless you have time to look quickly now, is to weigh in on a bill eight sixty that's not in this committee, it's in human services right now, and it's related to this idea of recovery and justice hub and spoke system. I would be interested to talk with you more about what those strengths and weaknesses of this proposal is without taking time up now. Second thing is, I don't know if you saw H eight fourteen, which is related to neurological rights, but it would be helpful to hear your opinion either on the record if we take testimony or just off out of here about the concept of neurological rights, because it's something that people don't even realize we're at the risk of losing right now pretty quickly. And if you know about this already, or any response to what I said is welcome, but I wanted to just say, I heard you and I welcome your feedback on certain things.

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: Do want to? You can

[Rep. Alyssa Black (Chair)]: go ahead.

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: Okay, I'll just jump in really quick in terms of the forensic piece and justice involved either adolescents or adults. Again, kind of going back to like the Olmstead issue is that I think if you looked at like the census of our hospitals and the capacity of our hospitals, so capacity parts and then census. So many of our hospital units have a certain number of beds available. They're not full. We have units that are completely not utilized, but we still have to pay for those units because they're there, they exist. And so we're still, we're not staffing the existing facilities. So the thought of building more or building new and building different seems like a waste of money when we have existing facilities we just need to invest in people and changes to the therapeutic programming that's necessarily offered there. Corrections is definitely not the place for people struggling with significant mental health, and we do a lot of work in corrections around that piece. So I agree that there could be and what I've heard when we've participated in testimony around a forensic facility in the past is that this is a very small group of folks we're talking about. And then when you but when you consider building or investing in a facility, that is millions of dollars out of the gate for maybe potentially like two or three people. And so we just have to think about how can we do that smarter. And then I will turn it over to Nayeela, and I will look into both of those.

[Nayla Reminski (Mad Freedom Advocates)]: Yeah, thank you. I will definitely look into those bills more. So thank you for providing those. I think I'm in my work inpatient with folks when I've gone into the hospitals, so many people there are there because they are not allowed to leave because they don't have housing, are there because there's no other programs that are lesser level that they're able to go to. And I think that sometimes there's this feeling of, Okay, we must keep building these facilities because they're awful and there's nowhere to put them. And we're not really going backwards. And I think when we're talking about a forensic facility, that is deeply concerning to me on a personal and legislative level, organizational level, because we are really getting the message that there are people in our community that we just want to siphon off and we don't want to deal with. And when we ever, we try to put it as like a kinder, gentler someplace else, but we're just creating the same problems that have continued, right? This is just a life sentence without a trial, really. It's telling someone that we don't agree with the way that you exist in the world, and therefore we need you to be separate. And I think that there are so many ways through the systems that already exist and ways that we haven't explored yet that we can help those folks differently. I think when we talk about peer to peer programs in schools, I mean, that is such early on talking about how we support each other through lived experience and through people who understand how we got to that point. But yeah, the stories that I hear, I think, are different than the stories that are told in some of those hearings when people are trying to be pro these different facilities. And I understand where that's coming from. And also, I think when you talk to people with lived experience and people who are currently in those facilities, you'll hear that the vast majority of stories are people who can't get out and could if they were given the resources to do so.

[Rep. Lori Houghton (Member)]: Well, thank you so much for testifying today. I really feel like your voice has been missing in this room, and I appreciate your openness about your own experience and just can't underscore enough the value that it brings to informing us, especially me because I write a lot of mental health legislation.

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: Can you just quickly

[Rep. Lori Houghton (Member)]: weigh in? I know right now downstairs, there's a discussion about involuntary care, and I'm not even sure what it is. But I'm not sure if that's the forensic facility that you all are referring to. But what do we do if someone is accused of a crime, they have not stood trial yet by reason of insanity. So they're still innocent. But they're not competent to stand trial. So the only thing we need to do is provide this person care, but they're a danger to themselves or to others. If that's me, where should I go so that I can receive care and also not harm myself?

[Nayla Reminski (Mad Freedom Advocates)]: You all feel it. How about it? Yeah, that's a great question. I think that is the question, honestly. And I think there are a lot of different ways that we could talk about that. And I would love to continue talking about it at this space, because I know we're short on time. But I think one of the first things is that we have people who want to seek voluntary care. And we're not letting that happen. We are saying you need to have this sort of EE in order to get care. But we have some resources. We have care respites where people have avoided emergency rooms, have avoided all of those things. And if you talk to Free Her Vermont, you'll hear about all of the resources that help people to get support before they're justice involved in the first place. And so I think if we're able to provide the care that people need, it usually prevents from getting to that level. And so I think also it provides space for people who want that support before they get into a situation. I've heard people say, I started to have non consensus reality experiences, and I was scared that I was going to hurt somebody, and I couldn't get care. And then that happened. And then they're sentenced to, again, as they call it, a life sentence. That's what I would describe that. Most people feel that way when they're in an institution, and they don't know when they're going to be able to get out or what they need to do to get to that point. So I think when we can really listen to what people need, most of the time that's avoided.

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: Yeah, and just to piggyback off of that, I think the laws already exist. If somebody is a danger to themselves or others, we have a mechanism for getting treatment and hospital level of care, both on the IDD side of things and on the mental health side of things. And so I just don't think we need to do more of that when the law allows for it already. And the voluntary piece is really important. I see, and this is why community supports is so important. The majority of people who are stuck in emergency departments are seeking voluntary care. They're not waiting. They're not held involuntarily. They're there because they need somewhere to go and there isn't a place for them to go. So I think that's also something to keep in mind.

[Rep. Lori Houghton (Member)]: Sorry, our turn had to step out.

[Rep. Francis McFaun (Vice Chair)]: Any other questions?

[Rep. Brian Cina (Member)]: I just would like to say thanks again. I wish we had more time to talk, have a discussion with you. Maybe we can bring them back for bills in the future. I think we often do forget, but we don't forget, it's just that we often get bombarded with the people who are players in the institutions and they have the means to surround us constantly, so it doesn't make space for your voices, the voices of people who are most impacted, so it's helpful to be reminded.

[Rep. Lori Houghton (Member)]: Meanwhile works on bills with me, actually.

[Rep. Brian Cina (Member)]: No, I work on bills with people out of this room too.

[Rep. Alyssa Black (Chair)]: They're never invited in here, I asked,

[Rep. Brian Cina (Member)]: and that's the issue I'm getting at home. Let's see

[Rep. Francis McFaun (Vice Chair)]: what we can do about doing that.

[Rep. Brian Cina (Member)]: All right, thank you.

[Rep. Francis McFaun (Vice Chair)]: Let me just finish this up by saying that there are people that are working on exactly what we are talking, and have been working on it for several years. When you talk about housing, there are at least three that I personally have been at. One in Moncton, Burlington, Randolph. So, people are working on it, it is slow, slow, slow. But I was around when they closed Brandon Training School. We promised you exactly what you're asking for now. Yeah. And there are people in this building that are working. Okay.

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

[Lindsay St. Amour (Executive Director, Disability Rights Vermont)]: you so much. Thank you.

[Rep. Brian Cina (Member)]: Send me an email if you want about the things I asked.

[Rep. Alyssa Black (Chair)]: Yes, come back. Okay. Yes. One hundred fifteen

[Rep. Francis McFaun (Vice Chair)]: back at one hundred fifteen.

[Rep. Brian Cina (Member)]: Alright,

[Rep. Alyssa Black (Chair)]: I'm still on live.