Vermont Legislature SmartTranscripts:

[Rep. Alyssa Black (Chair)]: Hi, welcome everybody. Afternoon, April 30, we have Led to Counsel Katie with us and we're going to kind of going back into I am so sorry, I can't even remember the 93. Everything one has to have a nine this year. This is around the forensic facility, we looked at and took a little testimony on it. We're going to get an update on what other committees are working on and then sort of discuss amongst ourselves.

[Katie McLennan (Office of Legislative Counsel)]: Okay. Good afternoon. Katie McLennan, Office of Legislative Counsel. So maybe before we look at language, just stepping back, there are, as I understand it, four committees on the House side that are taking testimony and looking at S-one 193, which is the bill about the forensic facility. I know that Human Services has been taking a lot of testimony, but I haven't joined them for much of that. So I'm not sure where they are yet. I have spent a lot of time with corrections and institutions, and Eric has been spending a lot of time with the House Judiciary. So House Judiciary is really focused on the process of how somebody gets to a forensic facility. Like, what does that judicial process look like? And I know that they have worked on language. I don't think it's finalized. But one element or change of the draft that they've been looking at is instead of having the Department of Corrections being the entity that is operating a forensic facility, they have that responsibility going to the Secretary of Human Services instead. Meanwhile, House Corrections and Institutions has taken testimony and has spent a lot of time sort of thinking through some of the big issues that are coming up as they look through who is being served, who is serving them, what are the services, where is this happening? And they first put together sort of some bullet points of some of their priorities and conclusions. And based on that, I have put together, I won't call it draft language because it's sort of piecemeal at this point. It's a document with language in it, but it is not a bill. So I think the process that is being currently contemplated is that the bill will formally move from house judiciary to house Corrections and Institutions. And at that point, there could be maybe a strike all to integrate some of this language that House Corrections and Institutions has been working on into it. Some of the things they're interested in doing, I'm hesitant to draft yet because I think it depends on what other committees are thinking, particularly around what the definition of a forensic facility is. They have decided they don't like the definition of the bill. They've looked at past definitions from past bills, I have liked those definitions a little bit more. So I think they've made a decision to build on past work in terms of the definitions. But without knowing the who of who is going to be served at the forensic facility, marking that stuff as a little premature, I think. So that is the process and where we are. So would you like to see this language? Love to see the language.

[Rep. Alyssa Black (Chair)]: We have be in the light.

[Rep. Brian Cina (Member)]: We're just seeing it, right? We have no control over it?

[Rep. Alyssa Black (Chair)]: No. How do

[Rep. Leslie Goldman (Member)]: we get this for a poll?

[Rep. Alyssa Black (Chair)]: In the language you're going to show us, is the definition a forensic facility in that language at all?

[Katie McLennan (Office of Legislative Counsel)]: No, but I can show you the past legislation that they're looking at. Alright. And so you'll see markups on this that is not necessarily meaningful to your work. That's just changes as they're happening. Okay. So this is sort of pieces of language. So there is this legislative intent language that it is the intent of the General Assembly that the Department of Corrections shall not operate or staff a forensic facility, with the exception that employees of the Department of Corrections may provide security around the outside perimeter of a forensic facility if it is fully located on the grounds of a correctional facility. So while there has sort of been a decision that a forensic facility wouldn't be in a correctional facility, there was also discussion that perhaps a standalone building could be on the grounds of a correctional facility. So that is sort of one piece of the conversation.

[Rep. Alyssa Black (Chair)]: This language is not final. I think they're very much still working on this, but this is what we just talked about. As we talked about this legislative intent language, there were some members who were interested in either instead of this or in addition to this, having language right in the statute that would go into the green books that sort of says roughly the same thing. The concern that was raised downstairs is that DOC is under the Secretary of Human Services, so

[Katie McLennan (Office of Legislative Counsel)]: that by putting it under the Secretary of Human Services, what precludes the Secretary from saying, Okay, DOC, you have the lead responsibility.

[Rep. Alyssa Black (Chair)]: So I don't know if it

[Katie McLennan (Office of Legislative Counsel)]: will be legislative intent, this concept at least is sort of being discussed downstairs. The second piece of language is a feasibility plan. The committee downstairs has been pretty clear that this is different than a study or a work group. This is sort of what is the next step? What do we need to know to make a decision to get a forensic facility up and running? So this is asking that by January, the Secretary of Human Services submits this feasibility plan for the development and operation of a forensic facility, and this would go to seven different committees. The plan would address the following: The proposed location of a forensic facility, which shall be independent from a correctional facility, and if on the same grounds as a correctional facility, shall be separated by sight and sound.

[Rep. Leslie Goldman (Member)]: How do you do that? It's on the same thing.

[Rep. Brian Cina (Member)]: Yeah, what about, I mean, being nitpicky, but it's okay if we don't see or hear it, but we can smell it. It's just a little weird. Not that we have any control

[Rep. Alyssa Black (Chair)]: Do we want to add sight, sound, and smell?

[Rep. Leslie Goldman (Member)]: Any senses at all?

[Rep. Brian Cina (Member)]: Shall I be separated by all physical, emotional, mental, and spiritual senses. Okay. Can we just say shall be separated? Well, sort of does. But but it says only by sight and sound.

[Rep. Alyssa Black (Chair)]: You can smell it.

[Rep. Brian Cina (Member)]: That means you could even touch it, technically. If you don't see or hear it. See it? I don't know, I think I'm being nitpicky.

[Rep. Wendy Critchlow (Member)]: We're not going be patient.

[Rep. Brian Cina (Member)]: Know we're not. I just think it's strange that they focus on sight and sound.

[Rep. Alyssa Black (Chair)]: Well, I actually appreciate though, that they have, you know, that it's not just separate, but traditional facility and then five feet and a covered walkway becomes a forensic. So I mean, like that they did make the attempt to say, When we mean separate, we really mean separate. What site? Like how big a piece of land do you need to be separate from separate? Or sound. So you can't hear people screaming when they're restrained? What? A bell ringing? I think that is for AHS to I'm figure out a problem, but it's gonna guess.

[Rep. Brian Cina (Member)]: Is there the legal precedent? Like, that language

[Rep. Alyssa Black (Chair)]: Let's go in. Let's keep going.

[Rep. Leslie Goldman (Member)]: No, that's what I was Let's gonna

[Katie McLennan (Office of Legislative Counsel)]: keep moving. Okay, Subdivision 2. The proposed design plans for a forensic facility shall allow the ability to separate residents by sex or gender in clinical need. Number of beds within a forensic facility. The entity or entities responsible for operating and providing services in a forensic facility shall not be the Department of Corrections. The timeline for constructing a standalone facility or fitting up an existing standalone facility to operate as a forensic facility.

[Rep. Alyssa Black (Chair)]: Oh, can I stop for a sec? You said that there's conversation or concerns that if it's under AHS, that AHS, because Department of Corrections DOC is underneath them, that they could just do that. Wouldn't this language basically say AHS, but not DLC I of

[Katie McLennan (Office of Legislative Counsel)]: think that's a struggle. This is session law. So I think they're wanting something in the green books that sort of says the same thing. But yes, I think you can read this to say very clearly that it shouldn't be DOC in the plan you're getting back, but not include DOC. But I think that might not be strong enough for some people at the table downstairs, and they would like to see a line that specifically spells out in the Green Book language, it's not going to be operated by DOC. There's some discussion about nobody will be in the sole custody of DOC. They're imagining that there are situations where somebody might be in joint custody of MH and DOC, but that concept just came up. So there hasn't been much conversation there. Okay, so we talked about the timeline for either constructing or fitting up a facility, the estimated cost of constructing or fitting up a forensic facility, the proposed staffing levels, staff qualifications, potential contracting needs, and clinical services available at a forensic facility, including on-site competency restoration services. This was just added. They wanted to make sure that it wasn't a telehealth competency restoration service. On Subdivision 8, the physical and staff security plan, both within and around the perimeter of the forensic facility. So physical security, meaning like locked doors or locked windows and then staff secure, how is it staffed? Subdivision 9, whether any opportunities exist for out of state placement of the forensic facility population and clinically appropriate programming while the development of a forensic facility in Vermont is pending. So there's been some conversation about how long it might take to have something operational and that there are individuals in the interim who might benefit from competency restoration services or other programming that the forensic facility is anticipated to provide. And is there any avenue by which some of those individuals could be served at an appropriate placement out of state?

[Rep. Alyssa Black (Chair)]: Can you remind me, a couple of years ago when we did sort of amendments around seclusion and restraint, chemical or medicated restraint, I remember that we had to amend statute so that it would include a secure residential facility, in other words, River Valley. Do we have to go back and put our forensic facility into that area? Or did we add that? Because at the time we were contemplating that there might be a forensic facility.

[Katie McLennan (Office of Legislative Counsel)]: Are you asking if seclusion and restraint could be used at a forensic facility? Yes. So the changes that were made were specific to a secure residential facility, which is a specific type of facility. And that is also for people who have a clinical need. So they're falling under the for medication and voluntary medication statutes that are set out in Title 18. So if you wanted the forensic facility to be built with the And as it's being built, planned for the use of seclusion and restraint, this would be the place to articulate that. But this is not in Title 18? No.

[Rep. Alyssa Black (Chair)]: Okay. Well, I mean, it could be moved, but right now it's in, I think, Title 13, is the criminal procedures. Is there statute in in Title 13, around seclusion and restraint?

[Katie McLennan (Office of Legislative Counsel)]: To my knowledge. The proposal, as you saw, did deal with involuntary medication for the purposes of competency restoration. But when the original bill was drafted, it was drafted as the forensic facility being in a correctional being operated by corrections. It sounds like there's still discussions between the committees as to who will staff it. But potentially, if it's going to be staffed by Dale and DMH, I don't know if that means that we would be moving the language to another title or if it makes the most sense to keep the procedure part with the actual description of the facility itself. I'll have to think that through with Eric, but potentially it could change.

[Rep. Alyssa Black (Chair)]: Okay. All right.

[Rep. Wendy Critchlow (Member)]: Daisy,

[Rep. Alyssa Black (Chair)]: you're looking perplexed.

[Katie McLennan (Office of Legislative Counsel)]: I'll wait until Daisy's done. Okay, so there's a subdivision that the plan would include any recommendations for legislative action to effectuate the development of a therapeutic trauma informed forensic facility. Then there's the subsection B, excuse me, that during the August 2026 joint legislative justice oversight meetings, the Secretary of Human Services or the Secretary's designee is to provide an interim status update on the development of this plan that's being asked for.

[Rep. Alyssa Black (Chair)]: That's what you're going through. I'm sorry. I missed it. I was writing things down. See, this is why I don't take notes because I can't hear what I'm writing.

[Katie McLennan (Office of Legislative Counsel)]: This is interim report backs to Joint Justice over the summer. And then this section z is just an excerpt. Right now in section four of the bill that house judiciary is working on, there is this subsection b. This is language that Senate Health and Welfare had worked on to put some clinical components in place for the forensic facility. And so this is just literally like an extraction from their bill just to kind of mark it up and it will be all put back together. But you'll see that this is a change House Judiciary made. Instead of DOC, the Secretary of Human Services, shall establish and operate a forensic facility for the secure evaluation, treatment and care of persons who have been transferred pursuant to being not competent or NGRI. The forensic facility shall designed and operated in a manner that supports therapeutic recovery oriented and trauma informed programming in a therapeutic community residence, while maintaining appropriate levels of safety and security, not refuse any person that's ordered to admit and not require any clinical or diagnostic prerequisites for admission, That this language sort of depends on what is decided by committees on who is the who that's being served. Subdivision three, provide for the safe evaluation, treatment and care. That's just repeating the language from the lead in, including the ability to separate population by sex, gender to otherwise address clinical safety or operational needs as appropriate, including the possible operation of multiple facilities. Employ a clinical services director to oversee all forensic clinical and competency restoration services. Implement staff qualifications, licensure training and supervision requirements that are sufficient to ensure the persons transferred to the forensic facility have access to clinically appropriate care treatment services and supports. Ensure that a registered nurse or a physician is available to provide care to transferred persons twenty four hours a day, seven days a week. Ensure that persons receive clinically appropriate assessment and treatment planning.

[Rep. Alyssa Black (Chair)]: Can I back up a little bit? In the very beginning of this section, Care of persons who have been transferred pursuant to subsections 48.15A and 48.19A. Who are those? 48.8.15 and 48.19. That's the

[Katie McLennan (Office of Legislative Counsel)]: not competent to stand trial. So that's the language about not competent to stand trial and transfer to a forensic facility. And then 4,819 is the partner language, which is not guilty by reason of insanity and transferred to a forensic So everything that's not highlighted in this subsection B, that's all language from the Senate.

[Rep. Alyssa Black (Chair)]: I just wanted to refresh.

[Katie McLennan (Office of Legislative Counsel)]: So that's it. There is still, like I said, a lot of work that has to be done where sort of a chicken and egg problem. It's easiest to see language, but you can't see language until there are some decisions made. So I think it will come together at some point, but we're not quite there yet. Would you like to see that definition? Yes,

[Rep. Daisy Berbeco (Ranking Member)]: please.

[Katie McLennan (Office of Legislative Counsel)]: Okay. So this was 2023 at '27. I believe this is where it is. Looks like you don't remember that.

[Rep. Alyssa Black (Chair)]: Oh, yeah. Yeah. It's going by and back.

[Katie McLennan (Office of Legislative Counsel)]: I'm gonna

[Rep. Alyssa Black (Chair)]: Oh my god.

[Rep. Karen Lueders (Member)]: I think

[Katie McLennan (Office of Legislative Counsel)]: this is the right one.

[Rep. Alyssa Black (Chair)]: Spent so much time on that.

[Katie McLennan (Office of Legislative Counsel)]: I'm not certain if this is the right one. There's been a few forensic facility bills. Yeah, this is the right one. Okay, so this definition of a forensic facility means a residential facility licensed as a therapeutic community residence. That means something very specific. That is a licensed type. The Dale licenses therapeutic community residences. That doesn't mean that it has to be operated by Dale, but that is who is doing the licensure. So it'd be licensed as a TCR for an individual with a mental health condition or intellectual disability if the General Assembly determines that commitment to a forensic facility is appropriate for an individual with intellectual disability. When this was debated, it was uncertain if individuals with intellectual disability should be in a forensic facility. So this A needs to be, if you decide to move forward with this definition, this A has to be updated based on what the decisions are in the house. B, the person is charged with a crime of violence against another person, and the individual is assessed not competent to stand trial or was adjudicated not guilty by reason of insanity. Again, this would have to be changed to conform with whatever decisions that are being made by a house judiciary. This is a much broader population than what is currently in the bill. Currently in the bill, it's limited to individuals who are alleged to have committed a crime or have committed a crime that carries a life sentence. So that's much narrower than crime of violence against another person. C, who requires treatment or programming within a secure setting for an extended period of time. I'm not sure what we'll do

[Rep. Daisy Berbeco (Ranking Member)]: with that. But what's an extended period of time? That's sort of the concern.

[Katie McLennan (Office of Legislative Counsel)]: And then you have a definition of cross site to secure. What does secure mean? So we could or could not include that. But when House Corrections and Institutions saw this, they preferred this direction over what was in the bill that House Judiciary is looking at. So they're moving to maybe modify this in some way instead of use the definition that's currently in the bill.

[Rep. Alyssa Black (Chair)]: Questions for Daisy Berbeco?

[Rep. Daisy Berbeco (Ranking Member)]: Thanks for showing us that, reminding us.

[Rep. Alyssa Black (Chair)]: Yes, Karen, well, is more

[Rep. Karen Lueders (Member)]: of a matter of disclosure, I'm familiar with this issue, you know, and so my son's been working on it for a while in his various capacities, so I'm not unfamiliar with the need

[Rep. Daisy Berbeco (Ranking Member)]: for this issue. So I

[Rep. Karen Lueders (Member)]: just want the committee to know that, and I'm obligated to make a decision. But

[Rep. Alyssa Black (Chair)]: I just want folks

[Rep. Karen Lueders (Member)]: to know I'm not unfamiliar with the issues.

[Rep. Alyssa Black (Chair)]: You have thoughts about the issue?

[Rep. Leslie Goldman (Member)]: But we don't get to make a decision. You don't get to make a decision.

[Rep. Alyssa Black (Chair)]: No, I know. But I am Yes, we do.

[Rep. Karen Lueders (Member)]: Mean, can discuss the group and ask to look at it.

[Rep. Brian Cina (Member)]: Are we having a discussion or are we still asking Katie questions? Because I don't want to hold Katie hostage while we have a discussion. I have things to say about it, but I thought we were only asking Katie questions.

[Rep. Alyssa Black (Chair)]: I have a question for Katie. I think it's a question, and it's more along the lines of the original bill that they're working on, just the totality of the bill. So, I'm trying to remember, we're in the lane of the peninsula. So, this bill, it seems as though you're talking about individuals with a certain segment of crimes, it's defined in there what the crimes are, if they are not competent to stand trial, found not competent to stand trial, or deemed innocent. Not guilty by reason. Not guilty, thank you. I'm just trying to think of not guilty by reason of insanity. This establishes a forensic facility in which they can be held if it is determined that they still pose a risk.

[Katie McLennan (Office of Legislative Counsel)]: I think you're starting to get into Eric's territory.

[Rep. Alyssa Black (Chair)]: I'm thinking where What if somebody is sort of stabilized? And I'm worrying, I'm not worrying, I'm wondering about the flow of an individual. Mean, right now, if their mental health condition is either dysregulated or they're in need of treatment, then they would be moving, would they be moving out of a forensic facility, maybe into the state hospital or secure residential? And then when they're no longer deemed in need of treatment, would they be moving back to a forensic facility? Is there a level where In this bill, is there also a level where you no longer pose a risk, but you don't pose a risk because you happen to be regulated at the time, but do you just cast someone out or is there supervision in any way? I mean, is there like, I'm trying to figure out where, like, the levels of supervision this flow and are we leaving anything out or it which brings me back to in the original bill. What if somebody doesn't meet the level to be in a forensic facility because they are and you use the language can't remember what the language was that you use.

[Katie McLennan (Office of Legislative Counsel)]: Want me to try to jump in?

[Rep. Alyssa Black (Chair)]: Yeah, please. There are so many questions in that. I know, I'm just trying to figure out this full flow.

[Katie McLennan (Office of Legislative Counsel)]: So I do think that House Judiciary is wrestling with a lot of these issues that you're raising about, that there might be different patterns of where people are placed. I believe, but I have to confirm with Eric, that what House Judiciary has decided is that if somebody has a clinical need, if they are a person in need of treatment, then that is the placement that they will have through DMH, whether it's at a hospital or an ONH, in a secure residential or in the community, that that takes precedence. That doesn't mean the person wouldn't necessarily come back to a forensic facility when they are no longer meeting the standard for a person in need of treatment if they meet the other criteria to be in a forensic facility. But I believe that that sort of clinical need takes precedent over staying in a forensic facility. So I will double check that that is the direction that House Judiciary was headed. What was the next question?

[Rep. Alyssa Black (Chair)]: So that seems to address that issue, but I'm wondering

[Rep. Daisy Berbeco (Ranking Member)]: if you're

[Rep. Alyssa Black (Chair)]: What happens when you no longer the need is felt that you need to be in the forensic facility, now where does somebody go?

[Katie McLennan (Office of Legislative Counsel)]: So my understanding from Eric is that a house judiciary is building in more off ramps out of the forensic facility. But if somebody is The term I think they're using is not restorable. So it's believed that the competency restoration won't be successful, or the person is not guilty by reason of insanity, to continue to hold the person, the person has to demonstrate a certain level of violent behavior. And the court has to make that decision and order the person to continue to be held. And there are check ins at regular intervals. But the concept is not just that the person is not restorable, they're there forever. They also have to have that court recognized degree of propensity for violence or to cause harm to others. So I would say if a person is no longer showing that, or if the court finds that the person is no longer showing that, even if they're not restorable or not guilty by reason of insanity, that's sort of the off ramp out of the forensic facility. The current bill does have, well, as it came to you from the Senate, had DOC, now it has AHS, sort of monitoring the person after they're released from a forensic facility. That is something I know Corrections and Institutions has members that want to think about that more. I don't think they've done all of the work that they want to on that issue yet. They know they don't want DOC to do it, but they're not quite sure what that monitoring will look like. Right now, the bill sort of has monitoring. If at some point the standard is met, the person is showing that certain degree of violence, the court could order the person back to the forensic facility.

[Rep. Alyssa Black (Chair)]: I think that's what I was trying to get to. Wouldn't that be DMH in the case of our purview? Would DMH

[Katie McLennan (Office of Legislative Counsel)]: be monitoring? Right now, the Senate version was DOC, the language that's being worked on, and House Judiciary Secretary. I think that's a policy question. Should there be monitoring? What should it look like? Who should do it? At what point is the person pulled back to a forensic facility and with what type of approval? Those are all policy questions. Well,

[Rep. Alyssa Black (Chair)]: I think that because it crosscuts DMH and Dale, would it be, maybe I don't want to speak for you, would that be accurate why AHS is sort of referenced

[Katie McLennan (Office of Legislative Counsel)]: part of the conversation, but I imagine that they're recognizing that there are people with mental illness, people with TBI, intellectual disability, possibly people with substance use disorder as their underlying qualifying condition. So to try to pull in all of those departments, I think is probably why AHS was chosen.

[Rep. Alyssa Black (Chair)]: Not DOC.

[Katie McLennan (Office of Legislative Counsel)]: No. At some point there has to be some conversation about, is one department taking the lead or is there sort of a hybrid approach that multiple departments might be implicated? How is that going to work?

[Rep. Alyssa Black (Chair)]: Anybody have any other questions for Katie?

[Rep. Wendy Critchlow (Member)]: It's just as confusing as it was at the big family. No,

[Rep. Alyssa Black (Chair)]: not your fault. It just

[Rep. Wendy Critchlow (Member)]: doesn't seem seems like it's not complete, really yet. Like, it's

[Rep. Alyssa Black (Chair)]: I think that's what happens when four committees are all working on one bill at the same time. Does that usually happen?

[Rep. Brian Cina (Member)]: Well This happens when one committee works on one bill. Sometimes. We've just been lucky this year.

[Rep. Alyssa Black (Chair)]: I mean, it falls under the jurisdiction of so many different committees.

[Rep. Leslie Goldman (Member)]: So, how do we converse about it and how do we communicate the conversation? Is that what you I

[Rep. Alyssa Black (Chair)]: don't know, let's have the conversation and then we'll figure out whether or not we need

[Rep. Brian Cina (Member)]: to Yes, some meeting

[Rep. Alyssa Black (Chair)]: Now

[Rep. Brian Cina (Member)]: is the time. Just don't want you to be in the middle of it. That's why

[Rep. Daisy Berbeco (Ranking Member)]: I was waiting. Trying to figure out.

[Katie McLennan (Office of Legislative Counsel)]: Can we go sit over there?

[Rep. Brian Cina (Member)]: You're welcome to sit there. Didn't want you to see like this without you. You know what I It just, I didn't want my critique to land in a moment where it might be perceived as directed at the lawyer. You know what I mean? So that's why I was like, let me wait till you're done. So this idea Before

[Rep. Daisy Berbeco (Ranking Member)]: you get started, I just

[Rep. Karen Lueders (Member)]: wanna make sure the version draft 1.1, that was on the site today, is that the most

[Katie McLennan (Office of Legislative Counsel)]: recent I change in the think that test judiciary has a more updated version. But again, that's not what those fractions have. They've been looking at big policy issues to come up with the language I showed you. Great.

[Rep. Brian Cina (Member)]: Whether or not a bill is in this committee, every single one of us as a member has a right and a duty to speak on an issue. And if it's not in our committee, then it's on the floor. So I just want to start by saying that so I'm not going to let anyone tell me that I can't weigh in on anything ever. So it bothers me when people are like, your committee can look at this, but you can't say anything about it. Yes, we can. If we don't say it here, then it's going to be on the floor. So let that be publicly known. Not in a threatening way, just like it's not okay. I feel like there's a trend in this building to silence members.

[Rep. Alyssa Black (Chair)]: I should clarify that we're being asked to weigh in as a committee. So, I mean, the question is, do we as a committee want to have a committee voice?

[Rep. Brian Cina (Member)]: You're offering Yeah,

[Rep. Alyssa Black (Chair)]: that's why we're being asked to leave.

[Rep. Brian Cina (Member)]: So I'm gonna let that point go, because are hearing the opposite from you. Everybody

[Rep. Alyssa Black (Chair)]: obviously gets an individual voice to aid.

[Rep. Brian Cina (Member)]: So that being said, then I'll shift my focus. It was more that Leslie was like, we don't get to weigh in, and I was like, but we do.

[Rep. Leslie Goldman (Member)]: I feel confused.

[Rep. Alyssa Black (Chair)]: Yeah. No, I mean, we get to do a flyover of it, and if the committee, in its collective opinion feels as though we should be making recommendations to other committees because it does pertain to an area that we have jurisdiction over, which is Department of Mental Health, then we can make a decision whether as a committee we want to make any recommendations to the other committees. Every individual is welcome to make recommendations on anything they want, but they will be speaking in their voice, not the committee's voice. Does that make sense? Yes. Okay.

[Rep. Brian Cina (Member)]: What you clarified is that we are being asked to weigh in, even if the bill's not in our possession.

[Rep. Alyssa Black (Chair)]: I think we're being asked, are there any red flags that you spot in your dealings with Department of Mental Health and overseeing mental health care in the state that we want to make sure that we flag, or the committees that don't normally deal with this type of thing.

[Rep. Karen Lueders (Member)]: I have a question.

[Rep. Alyssa Black (Chair)]: Yeah. I guess I'm not a lawyer.

[Rep. Wendy Critchlow (Member)]: Weigh in lawyers. How do you know before someone has even got a child whether their crime has risen to life in prison.

[Katie McLennan (Office of Legislative Counsel)]: It's their charge, what they're charged with, if it's eligible for

[Rep. Wendy Critchlow (Member)]: So even murder, you don't know, it could be thirty five years.

[Rep. Karen Lueders (Member)]: Not what you're saying, as opposed to the charge itself. So if you're charged with a crime, you could have a license Okay. And

[Rep. Wendy Critchlow (Member)]: I don't know. I don't murder.

[Rep. Alyssa Black (Chair)]: No, no. I think the judiciary has, if I'm not mistaken, there are certain crimes that are eligible for.

[Katie McLennan (Office of Legislative Counsel)]: Yeah, Eric has been sharing the list of crimes. I think it's around 10 to 13. Some of them are first, second or third offenses, so the counting is a little fuzzy.

[Rep. Leslie Goldman (Member)]: So I'm curious to understand the role So if our jurisdiction is DMH, if I'm understanding, then I'm curious to understand what DMH's role is in this, and I'm not sure I get it yet.

[Rep. Alyssa Black (Chair)]: No one Is DMH named in the bill at all? No.

[Katie McLennan (Office of Legislative Counsel)]: Well, like for coming back on reporting and rulemaking, it's named. But it's not there. The individuals as it came over to you from the Senate, the individuals who are in the forensic facility are not in the custody of DMH. They're in the custody of the commissioner of corrections. Okay. Not not AHS, but commission That's what came over from the senate.

[Rep. Alyssa Black (Chair)]: That is AHS, though. Well, no, but it's not.

[Rep. Brian Cina (Member)]: Mean, They're underage. DOC's underage.

[Rep. Leslie Goldman (Member)]: I get that, but I don't think that that's the intent. So, well, the Senate, it was the Senate's

[Rep. Alyssa Black (Chair)]: intent that it would be DOC. Right. And I think it is the intent as it came to the House. I think I can safely say that all four committees that are looking at this have individually each decided that DOC probably isn't the best place for this. Am right in that assessment? I haven't spent time with Human Services. Okay. Oh, I can tell you. I you can what they definitely don't want the DNC.

[Katie McLennan (Office of Legislative Counsel)]: Corrections and institutions is where I've spent my time, and they do not. And then obviously, we saw the change from the House judiciary draft, so they have made that decision also.

[Rep. Leslie Goldman (Member)]: Okay, so I'm back to what is the role of DMH, since that is our jurisdiction? And I'm trying to understand that.

[Rep. Alyssa Black (Chair)]: Well, I think that because Okay, so within the Agency of Human Services, they have multiple departments. No, departments? Yeah. Departments. They

[Rep. Leslie Goldman (Member)]: have the Department of Mental Health.

[Rep. Alyssa Black (Chair)]: The Department of Health. They have the Department of Corrections. They have the Department of Aging and is Dale's? Independent Living. Independent Living, Dale. Department of Health. And the Department of Health. And I think because when you're referring to need or not need or when you're referring to a forensic facility and you look at the population that we're talking about here, not competent to stand trial or not guilty by reason of insanity, you have multiple different types of areas that could lead to that. It could be mental illness. Could be an intellectual disability, which would be Dale. It could be a dementia. Again, Dale. It could be a substance use disorder, which would be VDH, correct? So, I think that the intent of why it's moving to the Agency of Human Services is because each individual department within Human Services would then have responsibility over the individual based upon why that individual is in this situation. So that's why it's AHS.

[Rep. Leslie Goldman (Member)]: I get that. But what I'm not getting at is the DMH rule. Is it DMH that's going to be responsible for the periodic evaluations? If it's at AHS, who is responsible for the periodic evaluations? Which I saw one place a year, which seemed like every year, which seems like a really long But that helps.

[Rep. Alyssa Black (Chair)]: AHS cannot be in custody overt. You can be in the care and the custody of the Commissioner of DMH, the Commissioner of Dale, the Department of Correction. AHS cannot have custody over them. So AHS would then have to determine whose care and custody this person is underneath. But there's nothing in here that says

[Rep. Leslie Goldman (Member)]: DMH might have care and custody. Or is there?

[Katie McLennan (Office of Legislative Counsel)]: I think maybe a better way to frame this conversation might be what should be DMH's role? Because think you're crafting it and you're weighing in. You're kind of driving what DMH's role should be. And I'm assuming that it would be parallel, well, I shouldn't assume, but a parallel role maybe for Dale, if that population is decided should also be in the forensic facility. But I think maybe backing away from what is currently in the language to re envision what you think it should look like is maybe an easier place to start from. So what I would be curious about is

[Rep. Leslie Goldman (Member)]: who if I'm thinking about a role, then whose role would it be to ensure that the periodic evaluation is done to determine competency. Is that fair?

[Rep. Alyssa Black (Chair)]: That's fair. What would

[Rep. Leslie Goldman (Member)]: you like that role to be? Well, if we're dealing with competency, are we dealing with mental health? Not always.

[Katie McLennan (Office of Legislative Counsel)]: So competency in the judicial sense is different than the competency you're thinking of in the medical sense. With that said, somebody has to determine if a person is competent in a judicial sense, meaning that they understand the charges against them and can participate in their defense. So who should that person be? Is that a psychiatrist?

[Rep. Daisy Berbeco (Ranking Member)]: Forensic psychiatrist. Right. So that's

[Rep. Leslie Goldman (Member)]: who it would be. It would be a forensic psychiatrist. So who in AHS employs forensic psychiatrists? DMH. Okay, so then it should be DMH. Then it would determine competency

[Rep. Karen Lueders (Member)]: mean, there's also the situation where the person is found not to be restorable. So in that case, there would be a periodic violation of how they spell the danger. So that's just another iteration of that continuing that vision.

[Rep. Wendy Critchlow (Member)]: Because somehow they got there without DMH, correct? Got

[Rep. Leslie Goldman (Member)]: there with evaluation not necessarily

[Rep. Wendy Critchlow (Member)]: Well through that's what I mean, they got there without DMH even being involved. They could be. So I think it would be followed up with the same system. I don't know.

[Rep. Alyssa Black (Chair)]: Not necessarily. Know. I This is like way above. Katie, I am so sorry. I am like, just because we don't delve into this world, would people who are in a competency restoration, they would be held here, obviously, because we have the wild competency restoration. So if they would have a forensic psychiatrist is making a determination, like forensically what category someone would fall under before they would even begin some sort of competency restoration. Am I correct?

[Katie McLennan (Office of Legislative Counsel)]: I think the first thing that would trigger this is that there would be a suspicion that the person is not competent to stand trial. And then likely the defense attorney would ask for an evaluation with a court contracted evaluator. So I think that would be the first step. And then if the evaluation comes back, this person is not competent to stand trial, then I think the court starts looking at the other factors. Are they not competent to stand trial? Did they commit one of these crimes? Do they have an underlying qualifying condition of mental illness or intellectual disability or TBI or whatever? But the first thing that's going to happen is that someone is going to suspect that the person is not confident to stand trial.

[Rep. Daisy Berbeco (Ranking Member)]: Who's that person?

[Katie McLennan (Office of Legislative Counsel)]: Who would suspect the I imagine it could be the person's defense attorney. I imagine the court could unilaterally make that observation. Again, the court process is less my world than Eric, so We're not amending

[Rep. Alyssa Black (Chair)]: that process. We're not changing that process.

[Rep. Wendy Critchlow (Member)]: We're just trying to

[Rep. Leslie Goldman (Member)]: figure out where DMH might be. That's my understanding.

[Rep. Daisy Berbeco (Ranking Member)]: Oh, Daisy? Then Brian. I think it's, to me, we need to weigh in on more than DMH. This facility is somewhere that is, according to the drop language here, is treating and caring for people and judging by current practice, I don't know, nine point five out of ten of them are going to be people with mental illnesses. So those are the people in our jurisdiction. So I'm troubled that I I guess the Senate came up with a lot of the language that on the House side we would be coming up with, but it's troubling to not really be able to have the time to dig into this, though, because it is absolutely our business. I have a lot of thoughts on it, and I'm really glad that we're doing this because we desperately need this facility. But it needs to be therapeutic and recovery oriented. And I don't know that we're going to get that without closely working with the other committees.

[Rep. Alyssa Black (Chair)]: I just wanted to ask where the assessment that, I mean, I know it's not an exact number, but you said, basically, let's face it, nine out of ten of these people would be within the Department of Mental Health. That, from my understanding, that's not actually That's not true? I had sort of thought, and I had heard, maybe not in testimony, I sort of heard that it was about half and half.

[Rep. Daisy Berbeco (Ranking Member)]: People that go in under bail custody are often rehabilitated. People with mental illnesses have them for life. Competency Yeah, can be restored to where they understand and can be tried and stand trial. But people who are going to be in here and not leave are people with mental illnesses. That's what I'm talking about.

[Rep. Alyssa Black (Chair)]: I guess I had thought, and again, I know DMH is in the room, but I thought that in many cases, particularly because I think what human services is wrestling with is that the population affected by Dale, they will never get better. I mean, intellectual disabilities, TBIs, but that's not a restorative.

[Rep. Daisy Berbeco (Ranking Member)]: They are not going to be in the facility as long as folks with a serious mental illness. That has not been in the history. I don't know if DMH wants to correct me, but that was my understanding when I worked on S89.

[Rep. Alyssa Black (Chair)]: I

[Rep. Karen Lueders (Member)]: am not sure about the specific lenses today. It can be different to separate them

[Rep. Alyssa Black (Chair)]: into a particular treatment need.

[Rep. Karen Lueders (Member)]: Groups of the I will say my understanding of overviewing competency restoration literature is that competency restoration is a bit more effective for mental health, rate effectively as high as eighty one percent, I think, whereas for selecting developmental disability is lower, it's closer to sixty percent depending on the mental use and the particular person I see use.

[Rep. Alyssa Black (Chair)]: But we're talking about restoring competency, we're not talking about the numbers in Vermont with the people that were?

[Rep. Karen Lueders (Member)]: Yes, so for restoring competency for mental illness, it's a higher percentage for intellectual disability.

[Rep. Daisy Berbeco (Ranking Member)]: That's not my point. My point is the people that are going to come into contact with this system, traditionally in Vermont, because we don't have a competency restoration process, are people with mental illnesses. But I think we're belaboring the point. My point is that this bill, I hope, as a committee, will have some input because I feel strongly that it is pertaining to people with mental illnesses. And I don't care if the MH isn't directly listed in it. I hope that they would be because I believe, Katie, that people that end up in the forensic facility are either in the care and custody of DOC commissioner or DMH commissioner or Dale commissioner. Is it

[Rep. Alyssa Black (Chair)]: one of those

[Katie McLennan (Office of Legislative Counsel)]: three? Under which iteration? Under the draft that came to you from the Senate, they would be in DOC commissioner. Sorry, no, the draft that we're looking at here. They wouldn't necessarily be under DOC or, sorry, DMH or Dale.

[Rep. Alyssa Black (Chair)]: Because it just

[Rep. Daisy Berbeco (Ranking Member)]: says AHS.

[Katie McLennan (Office of Legislative Counsel)]: It says AHS. So that's sort of the question to be answered. Yeah,

[Rep. Alyssa Black (Chair)]: so should we make the recommendation that they be within AHS and then under the care and custody of the relevant department based upon the person's underlying condition or some better language than what I just said, but sort of to the point. Yeah, it's clear to

[Rep. Daisy Berbeco (Ranking Member)]: me that we have to, at the entry point, have a connection to the people who are responsible for the care, safety and treatment, because that's exactly what this facility is responsible for. Yes, there is a secure component, but the reason these people are there is because they're sick and dangerous. But we can't ignore the fact that this isn't just a correctional bill or a facility's bill. This is about sick people.

[Rep. Leslie Goldman (Member)]: And it doesn't mention Dale

[Rep. Wendy Critchlow (Member)]: in this either. I won't do that. And there could be a lot, sounds like there's a lot that we could So AHS I see

[Rep. Alyssa Black (Chair)]: is like the conductor that would assign. But AHS must assign.

[Katie McLennan (Office of Legislative Counsel)]: Yes, that's what AHS cannot

[Rep. Alyssa Black (Chair)]: have custody over someone. Exactly. So AHS must assign someone to the care and custody of someone within their department. Their purview. Older than what's written here, which is anybody but DOC. Yeah. And it's probably going to be my goals too. We could work on making recommendations to spell it out which one they will be under.

[Rep. Brian Cina (Member)]: Players waving at you.

[Rep. Karen Lueders (Member)]: I would just say for anything outside of IKEA 48 parameters or DMH custody, there is no

[Rep. Alyssa Black (Chair)]: So we would have stipulated in here that there would be.

[Rep. Leslie Goldman (Member)]: Intellectual disability would be bail?

[Rep. Daisy Berbeco (Ranking Member)]: It depends if they meet that two party criteria. I don't know what that is. Salary MSC and DMH. A TBI would be a high custodial.

[Rep. Wendy Critchlow (Member)]: I would fall under Dale, would it not?

[Rep. Leslie Goldman (Member)]: There's no custody

[Rep. Karen Lueders (Member)]: for TBI.

[Katie McLennan (Office of Legislative Counsel)]: There's no statutory process for having a

[Rep. Wendy Critchlow (Member)]: Oh, so you just have to make it so that if they fall into this forensic, they fall into this category, then

[Rep. Alyssa Black (Chair)]: they would, right? Can you talk about February? We don't We've been with this a lot. So, sort of, I don't want

[Katie McLennan (Office of Legislative Counsel)]: to call it parallel to DMH, but in my mind, they're sort of parallel tracks in some ways. Two forty eight is different in that a person has been involved with the criminal justice system. They've been found not competent to stand trial. They have an intellectual disability. And the court has found that they are dangerous to others. And so two forty eight creates a civil commitment process whereby the person is committed to the care and custody of the Commissioner of Dale. And they're placed in a residential setting. We don't have a facility like a hospital. It's often one or two people in a particular setting. I have a document about it, but it talks about some of the So in these programs, it could be residential support, arm's length or eyes on supervision when the person is outside their home, education and day activities, employment support and supervision, respite, individual therapy as needed, group therapy as needed, psychiatric and other medical services, family training and support, a case manager. And then there could be restrictions on their living situation, including alarms on windows and doors, having an awake supervisor overnight, restricting the person's access to settings where children may be present, GPS tracking bracelets.

[Rep. Alyssa Black (Chair)]: So there is a process under Dale, but there's not a process under DMH for that unless the person is in need of treatment. Only in need of treatment that they can be on a order of hospitalization. Am I right? Sorry, I missed your question. Basically there's a process under Dale for that, but there's not with DMH Unless the person is in need of treatment, that's the only time they can be

[Rep. Daisy Berbeco (Ranking Member)]: Oh, I'm under the the custody.

[Katie McLennan (Office of Legislative Counsel)]: Yes. Person has to need clinical care to be in DMH custody.

[Rep. Daisy Berbeco (Ranking Member)]: That was going to be my next recommendation. Was there any discussion in judiciary that you recall about connecting an ONH requirement? Requiring that someone be on an Oh to be in here. The forensic facility? Yeah. I know it's not a hospital, but could it be equal with hospital level of care?

[Katie McLennan (Office of Legislative Counsel)]: No, not in this iteration. There conversations at some point within the past five to six years about the first prerequisite to be in a forensic facility would be to be under the care and custody of one of the commissioners. But that doesn't sort of get you out of this situation. So right now, if somebody does need the profile of somebody who'd be in the forensic facility as described in this bill, and they're in DMH custody, DMH can only hold them until they're no longer a person in need of treatment. So that still has the person being released potentially even though they might have the underlying level of dangerousness that I think this bill is trying to capture that population.

[Rep. Daisy Berbeco (Ranking Member)]: Got it.

[Rep. Alyssa Black (Chair)]: So there is the issue, Daisy, on one second.

[Rep. Daisy Berbeco (Ranking Member)]: Daisy, I didn't want to cut

[Rep. Alyssa Black (Chair)]: you off because you were, when you started and you were thinking you I'm

[Rep. Daisy Berbeco (Ranking Member)]: trying to connect either a person being on an ONH or an Oh so that they're always in the custody of the commissioner. And the intent would be there that I know there's a really serious link with these folks to victims' rights and making sure that

[Rep. Karen Lueders (Member)]: that we don't

[Rep. Daisy Berbeco (Ranking Member)]: muddy criminality and mental illness, and that when someone is ill, that they are appropriately placed under the commissioner of the appropriate department. Am I making sense? Yeah. The commissioner needs I guess I'm just contemplating how if somebody is no longer in need of treatment, but they're still dangerous, why wouldn't they just go into corrections? They would go be tried. They'd be tried, right?

[Rep. Alyssa Black (Chair)]: And then go into corrections. What if they've already been tried And they've been found Not guilty of their receiving sanity.

[Rep. Daisy Berbeco (Ranking Member)]: Then they're in the forensic facility.

[Rep. Alyssa Black (Chair)]: And whose custody are they under?

[Rep. Daisy Berbeco (Ranking Member)]: They're under DOC unless they are in need of treatment.

[Rep. Alyssa Black (Chair)]: Well, right? We're basically saying DOC is the last party that should be.

[Rep. Daisy Berbeco (Ranking Member)]: But isn't everybody in this facility in need of treatment? Isn't that why they're there?

[Katie McLennan (Office of Legislative Counsel)]: The DOC? Oh, the forensic facility. These are not people who meet DMH's definition of a person in need of treatment. They all have some type of qualifying condition, which I think is sort of, I'll have to look at the most recent language in the bill, but it's not linked to a particular level of acuity. That's

[Rep. Daisy Berbeco (Ranking Member)]: what I'm getting at. To

[Rep. Alyssa Black (Chair)]: be in a hospital level care, you have to be in need of treatment, you have to be sort of in a restorative, but when you no longer meet that level of care, can't be there. This contemplates for an extended length of time, I think, where this person may not be in need of active treatment and yet they're not safe to be returned to the community. If they're not safe, need him back to treatment. Yeah, exactly. I know, I get that too, but we kind of asked DMH that the other day, which is, I mean, just the very fact that you don't believe they're safe to return to the community, doesn't that mean that they're not?

[Rep. Leslie Goldman (Member)]: They need treatment. Need treatment.

[Rep. Daisy Berbeco (Ranking Member)]: That's why I'm going to tie it to an ONH. It's like, if your treatment is not of that severity that you need to be under the watch of the commissioner, Why are you there and not in the community? Well,

[Rep. Alyssa Black (Chair)]: I think that was kind of the question that is being posed in, did you say judiciary or corrections, which is what about this? You're on an ONH, you don't need the high level at a forensic facility, you don't qualify under order of hospitalization, but you're in the community and where shouldn't you be under the care and custody when you're on an ONH, but you're not dangerous because you have maybe been in a therapeutic place where you're sort of not dysregulated but then you still need some sort of supervision to ensure that you maintain that. And it's like we're missing that level. So who's the supervisor?

[Rep. Leslie Goldman (Member)]: Who's doing supervision? That's what we're talking about.

[Rep. Alyssa Black (Chair)]: Yeah, should be DMH.

[Rep. Leslie Goldman (Member)]: It should be DMH. Those people and then there's Dale and then there's this group that has no one, the TBI group. I don't know if there's anybody else. Dementia, but dementia will go to Dale. Don't know. I'm sorry? Substitutes.

[Rep. Alyssa Black (Chair)]: Would Kat go to Yeah, under the trust against the Department of Health.

[Rep. Leslie Goldman (Member)]: That's where I was going. Could that be the I

[Katie McLennan (Office of Legislative Counsel)]: think that is the point that HS is making is that not all of the commissioners currently have people in their care in custody. So that would be something new that you'd be creating, that somebody could be in care in custody of the Commissioner of Health based on their substance use disorder.

[Rep. Leslie Goldman (Member)]: Well, about based on their TBI? I mean, that's a medical diagnosis. You think the guy's a doctor No.

[Rep. Alyssa Black (Chair)]: A Dale?

[Rep. Wendy Critchlow (Member)]: TBI is Dale. Sound good?

[Rep. Leslie Goldman (Member)]: I think TBI is a medical diagnosis. They don't

[Katie McLennan (Office of Legislative Counsel)]: have all the programs

[Rep. Wendy Critchlow (Member)]: for me. Yeah.

[Rep. Daisy Berbeco (Ranking Member)]: How do we of coalesce our thinking on this?

[Rep. Alyssa Black (Chair)]: Well, wanted to ask you because you had mentioned you know, just sort of ensuring that this is a therapeutic recovery oriented, trauma informed, and I'm wondering if the language in here that came from Senate Alban Welfare, I'm wondering if this meets what you're talking about or if you feel it needs to be strengthened. This is the language that Katie put up. I don't know if we have that. Do we have that? The draft language from corrections and institutions? No. Would you like No, I get it. I got it. Did she get it?

[Rep. Daisy Berbeco (Ranking Member)]: Oh, I went to 193, the bill page. Go to the bill page and then click on committees. You're looking at 3.1.

[Rep. Leslie Goldman (Member)]: I went to judiciary,

[Rep. Alyssa Black (Chair)]: you went to correction. Actually draft 2.1 HCI. Send that to Tasha. Today's date, yeah, is the language that Penny

[Rep. Daisy Berbeco (Ranking Member)]: has kind of walked us through.

[Rep. Alyssa Black (Chair)]: Yeah, so the section Z, how are you feeling about, do you feel like this addresses your concerns, or?

[Rep. Daisy Berbeco (Ranking Member)]: I'm not prepared to answer that right now.

[Rep. Alyssa Black (Chair)]: Oh, that's alright, I want to. Do you want me to move on to Brian and we'll come back? Yeah. I mean,

[Rep. Daisy Berbeco (Ranking Member)]: how are we going to coalesce our thoughts? That's what I'm looking for. Is some direction like, is judiciary expecting a memo from us? Are they expecting that today, tomorrow?

[Rep. Alyssa Black (Chair)]: I think that this is, I think the judiciary has another draft coming, and they're taking it up next week, and there is time. There is time. So,

[Rep. Brian Cina (Member)]: some questions I have are how does this proposed facility fit into the continuum of care that already exists? Because we're supposed to have a continuity of care in every possible setting, and we know there's disparities with access to healthcare in correctional facilities right now. So if we're going to be building another component of the system of care that's embedded, even if separated by sight and sound, if it's embedded in a correctional setting, my question is how does this care interconnect with the person's existing care? How are their existing providers involved in restoring competency? How do we maintain competency once they've complete the program if they're being detained in a correctional facility? How do we make sure that it doesn't lead to decompensation after we spend all this taxpayer money stabilizing them? So I would like to know how does any proposed facility fit into the continuum of care, and how is the continuum of care in the correctional system inter like, how is that maintaining continuity for people when they're incarcerated or detained? And I'm also wondering if we're going to invest in this kind of treatment infrastructure, what other situations might it help? How can we solve more than one problem with the same investment? Sometimes we're so focused on one thing that we spend all this money on it, and then we put like, if we're going to spend money on building some kind of restoration program for people waiting to stand trial, if there's openings in that program, might it be used to help people before they reenter into the community so they're reentering in better condition than they went into incarceration, for example. So there might be ways that we could be thinking of this more broadly.

[Rep. Alyssa Black (Chair)]: Can I just say one thing? Yeah. Competency restoration is a goal of competency restoration is to get someone to competency so that they can stand trial. And yeah, I mean, you had just said something about how do we keep someone's competency? And I don't think competency restoration has anything to do with keeping someone's competency. It has to do with getting them to trial. Which is

[Rep. Brian Cina (Member)]: part of the problem. It's like we spend all this money to get them to go to trial.

[Rep. Alyssa Black (Chair)]: Then we're like, all right, they're

[Rep. Brian Cina (Member)]: ready for trial. Dump them in a cell. Let's let their mental health decompensate again. Is that what's gonna happen? Because it's like wasting money just to jump over a hurdle. What I wanna know is once we restore competency, how do we how do we make sure that we don't lose that investment by throwing someone in a prison cell with another psychotic person and then they kill them, which happened in Vermont. Okay, that happened. So that's just one example. We do this too often. We spend money on these high level interventions, and then we put the person immediate You know, we spend all this money stabilizing someone's mental health, and then we throw them to the street from the hospital, and then they become addicted to drugs again, and they end up committing more crimes, And then they end up back in jail again. So how can we be breaking the cycle here in any investment would be a question I have. How do we invest in prevention at the same time? There could be things we could be doing as we invest in a forensic facility that prevent the need for a forensic facility. And I don't want to create a forensic facility at a high expense and then cut programming that's keeping people healthy, and then they end up committing crimes and in a forensic facility. So we need to think about the big picture. And I think DMH does have a role in that, because they're overseeing the entire continuum of care, from prevention to the highest level interventions. I would like to, if there's going to be any kind of feasibility study, I would like them to study the feasibility of community based restoration as much as possible, because there's a lot of evidence out there proving it. And I did some research while we were sitting here, and there's an example. The Miami Dade Forensic Assessment, sorry, the Miami Dade. Miami Dade, sorry, not Dale, sorry, that's a Freudian slip. Miami Dade County Forensic Alternative Center was established, let me look at the statistic here, took a screenshot. It's a patient admitted to this center had doubled the changes of staying out of jail the year following at half the cost and two thirds the length of stay in comparison to someone admitted to the state hospital. So I think what it shows you is that creative approaches to restoring competency could actually improve public health in general. And the last thing I would just say is I did have a proposal that ended up in human services, and no one has taken any testimony on it that I sent to one of our witnesses. I sent you all this email. I sent it to Kelly Carroll, remember the mom? And she wrote back and she said, I felt a bit rushed and wasn't comfortable talking any longer, but I wanted to follow-up on your comments. I think any approach that focuses on prevention and early intervention to keep people from escalating is worth exploring, and I hope that idea moves forward. Looking back, I would have preferred that Pronto received meaningful help when his behavior first began to escalate a decade ago. If a recovery based intervention had been in place, our paths may have never crossed. And then I sent her more details and she said, I like the idea. And she sent me a paper from someone that I forwarded to you all as well. But the point is, this is an opportunity to think bigger. I'm not saying we don't have a need for six beds to restore competency so people could stand trial, but if we're going to invest in that infrastructure, perhaps we should do it in a way that thinks bigger. That it's not just about those six people at any given time who are trying to get through the court system, but when people are incarcerated, there should be a way of assessing and detecting risks earlier before someone is bouncing in and out of jail to the point that they're hiding in the bushes and attacking a person and boasting like this guy Pronto did. Like, you read, it's really sad if you read the details of Kelly Carroll's story, how this man bounced in and out of our criminal justice and mental health system. And he literally wrote notes bragging about how he could kill someone and get away with it before he hit in the bushes and did that. If he had been flagged earlier in his states, maybe we could have prevented all that. And just because someone like that can't stand trial, now we're going to clear them to state of trial, I feel like it's this superficial thing we're doing without looking at what caused the problem in the first place, and that's kind of where I'll stop for now.

[Rep. Daisy Berbeco (Ranking Member)]: Can I just quickly note that the Miami Dade system, the sort of architect of that, Doctor? Leifman, came and spoke with the Vermont Commission on Mental Health and the Torks, and I believe Karen Barbara at DMH is consulting with them right now. So DMH is aware of that approach, and I think appreciates it as much as we do. That's it. I think

[Rep. Alyssa Black (Chair)]: all wonderful, wonderful thoughts. And I mean that truly, I'm not being facetious in any way. I think we have come to a place. First of all, I will just say that we sit around and we listen to enough testimony and have enough experience to know that we have many levels in our system of care that are inadequate or lacking or understaffed or under resourced? Would that be an accurate statement, particularly when we sit in this committee with mental health? There seem to be a lot of places where we are not putting the whole continuum of care together? I think so. Okay. I was just wondering if you would agree with that. I think that we have been talking about a forensic facility for quite some time, and we've done look backs and report backs, and do we really need, we've tried to amend existing, to reconfigure existing facilities, and I think the Senate has sent this bill across as this is a gap that we have, and we need this, and I think that's why it's before us right now. I guess that's all I was gonna add.

[Rep. Brian Cina (Member)]: I agree, I think it could just be done in a

[Rep. Alyssa Black (Chair)]: really I smart way, because agree.

[Rep. Brian Cina (Member)]: And those are all my points, but just like hope, it was throwing stuff out there hoping maybe some of the language would resonate with people and maybe we could offer suggestions to strengthen the language, like beyond, oh, trauma informed environment. Well, let's think

[Rep. Alyssa Black (Chair)]: about that language. Wait, go.

[Rep. Daisy Berbeco (Ranking Member)]: Related. The therapeutic residence licensing, I'm going to send it to you. I'll look at the language because a lot of what you said is required. Leslie? Well, I think, Brian,

[Rep. Leslie Goldman (Member)]: you make really important points about the continuum of care. I mean, I don't know what's in the middle, and I don't know where the forensic facility lands in it, but maybe it's over here because it's very unique in what it needs. But I do think someone needs to be in charge. And I think that's the question that I'm taking about is who's in charge of these individuals. And once again, I think that we've learned that DMH could be in charge of people with mental illness. Dale could be in charge of people with intellectual disability. I'm hoping we can find someone to be in charge of people with TBI or a medical cause of aberrant behavior, let's say. And I'd love for them to be BDH, but who knows? So to me, that's what's before us right now. How it fits into the continuum of care of mental illness, I'd love to do that too. But I'm not sure that's what this bill is.

[Rep. Alyssa Black (Chair)]: I was going say that, yes, absolutely. We need to be talking about the continuum care. But let's not forget what a forensic facility is. A forensic facility is for those that have, for whatever reason, been deemed to be unsafe to be in the community. And a forensic facility at its core is essentially public safety.

[Rep. Leslie Goldman (Member)]: So if we're going to come out with some recommendations to judiciary and AHS within the near future, because we don't have time to rewrite the world, what

[Rep. Alyssa Black (Chair)]: do we want to focus on? Yeah, and I think the question is that while essentially it is about public safety, we have the opportunity to ensure that it is not just about locking people up because we've decided that they're unsafe, that we have a chance to weigh in and say, how do we at least make this as good as we possibly can? I got Wendy. What is good?

[Rep. Leslie Goldman (Member)]: And to me, that's like what Brian's saying. It's a therapeutic environment to restore competency. Mean, that's That's the what we think it is.

[Rep. Wendy Critchlow (Member)]: I keep thinking, I'm with you, that I can't envision what this is. But then I look at John Dinkley, he was in a forensic place for forty years. So it could be that there's nobody in it. It could be somebody's there for a really long time. Like, do you know what I mean? I just can't envision that this is going to be an empty place. I'd see some in and out, maybe hopefully drawing to less but then there are people that could live their lives out there don't know.

[Rep. Leslie Goldman (Member)]: That's why I'm asking who's in charge, because who's going make the determination how often about where this person is going to be? And I think that coming out of this conversation, I'd like to see a recommendation that we

[Rep. Alyssa Black (Chair)]: make, if we could agree. Could we see what the other three, four committees have come up with before we recommend? That's not our jurisdiction is DMA. I think what other committees have come up with is this language here. This is coming from corrections and institutions who has been thinking about that if we're going to have a forensic facility, who is going to be in charge of it? And they have made the determination that whoever it is, it isn't going to be the Department of Corrections. Which is why they've put AHS in there for the other departments underneath the AHS. So I think the Human Services Committee is working on recommendations very similar to this, and it is my hope that if we have additional recommendations, definitions if we want to include I mean, there is in this proposal talking about trauma informed, infectious faced, be designed and operated in a manner that supports therapeutic recovery oriented and trauma informed programming in a therapeutic community residence while maintaining an appropriate level of safety and security. So I think what this is trying to get at and maybe what I'm hearing from both Brian and Daisy, which is maybe we need to maybe recommend strengthening this a little bit. Is that what I'm getting? Well, I know I'm getting a lot more from you as well, but is that what I'm saying? Strengthening this language a little bit to ensure that we're that Coming back with some really

[Rep. Daisy Berbeco (Ranking Member)]: specific things, but I think this is a really, really well done PD.

[Rep. Alyssa Black (Chair)]: Yeah,

[Rep. Daisy Berbeco (Ranking Member)]: and I've been taking notes of the points that folks have been making, careful notes. And then personally, I want to just digest the bill a little bit more and see what direction they go. I might review some of the testimony in judiciary because they've been working on this for a few weeks.

[Rep. Alyssa Black (Chair)]: Good, and then I can have another.

[Rep. Brian Cina (Member)]: Oh, I have one.

[Rep. Alyssa Black (Chair)]: Okay. Karen,

[Rep. Karen Lueders (Member)]: it does sound like although the Senate came over saying the Department of Corrections, it does sound like all the committees on the House side are thinking differently about that, and that's evolving. But they are thinking somewhat similarly, in terms of having a separate facility, not embedded in collections. And there are I'm not the mental health expertise, but it does talk about when they're not dangerous anymore, the least restrictive setting is where they're being released to, it's a narrow build, it's people that could spend life in prison because they've done a very dangerous thing, and even though they can't stand trial, they don't have the competency to do that, they can still be a danger too. It's not, it's not broadly. It does seem like the communities are heading in the direction of, I don't know, more balanced than the people from the Senate, that's all the same.

[Rep. Alyssa Black (Chair)]: I wasn't in the Senate, I mean, happened, but I'm assuming that this came over from the Senate, because, if I'm not mistaken, that's what's happening now. These These people are within the Department of Corrections.

[Rep. Karen Lueders (Member)]: Or they're not, or they have to be released. They're in the community, and they're endangered, they continue to endangered. So that's the gap that's missing. That's the problem.

[Rep. Alyssa Black (Chair)]: Right, last word and then I can

[Rep. Brian Cina (Member)]: go Yeah, I just wanted, a point I wanted to- That's a nice long break. Was that it's just in response to the idea, the social construction, that this is a public safety issue. And what I would like to share is that in public health, that there is plenty of research showing that public health and safety are intertwined, here's one example, an article from 2017, it's called Public Health and Safety, The Social Determinants of Health and Criminal Behavior, and I want to read five sentences from it, and then I will leave it. If you want to read more, I'll send it to you. Just because it makes this point really clearly that it says, social inequalities, this is just an excerpt of something he says, social inequalities and systemic injustices affect health outcomes and crime rates. Poverty affects brain development. Offenders often have pre existing medical conditions, especially mental health issues. Involvement in the criminal justice system itself can lead to or worsen health and cognitive problems. Treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and a public health approach could be successfully applied within the criminal justice system. So his article is, that's in the intro of this article, where he basically goes through how all these different social determinants of health are also contributing to criminal behavior and how public health interventions and health interventions in the face of criminal behavior can actually reverse criminogenic behavior. And so my point is that public safety and public health are intertwined. So I don't think we can think about public safety without thinking about public health at all. So I'm glad that at least people are acknowledging that with this bill, but it's only because it mentions the Department of Mental Health and that we're talking about the structure of government that it ended up in this committee. Otherwise, I think the mindset of the building would have been, this is not your committee's issue to even touch. And I think that it's important when looking at public safety that we look at mental health, substance use, and other health conditions, and that we look at social determinants of health in general. Thank you for letting me say that.

[Rep. Alyssa Black (Chair)]: I agree, And I agree with you in absolutely the entire Department of Corrections and the entire public health should be reformed. But unfortunately, what we're dealing with now is when our public health has totally and completely failed. So that is what I would say that this is the facility that we are contemplating. And you are right about all of that.

[Rep. Brian Cina (Member)]: I think how we do this facility though, how we do it, can be a part of that change. You know what I mean? Like, I don't think we're gonna reform it on all of the bill, but we could certainly be thinking like from this It's like, we're performing surgery, And when we perform surgery on this part of the system, we're like, we're gonna clean up some of the scar tissue over here and over here too, so this joint functions better. We're not just gonna replace the knee and leave all the scar tissue around it.

[Rep. Daisy Berbeco (Ranking Member)]: So this eye functions better?

[Rep. Brian Cina (Member)]: We won't go into the eye analogies.

[Rep. Alyssa Black (Chair)]: Let's finish up. Okay, we are in Room 11 at 05:00. I'd ask everybody to be at least ten minutes early as we will start right immediately at 05:00. Because we have a long witness list to get there.

[Rep. Daisy Berbeco (Ranking Member)]: Can you talk about S-sixty four and what's happening? Because I'm getting bombarded with emails from committee members, from constituents, from legislators. We've

[Rep. Alyssa Black (Chair)]: got planning tomorrow afternoon and we'll get S64 on the agenda for next week. You said planning tomorrow afternoon? Just planning for like the next week's agenda.

[Rep. Leslie Goldman (Member)]: Okay, because just from our planning point of view, I thought we were

[Rep. Alyssa Black (Chair)]: done at noon. Yes, great. We are done at noon. I gotta sit with Tasha, and we'll plan for next week. So it'll be on the agenda next week. Okay. Alright. See you all at