 You're on the record Okay, so Becky Wasserman legislative council, you should have a hard copy of this draft recommendation because it is not posted yet So as you recall in the capital bill there was some language that said that BGS could use up to two hundred thousand dollars For their line item for the 2020 appropriation for statewide planning using contingency for an assessment To assess relative costs and resource requirements the potential construction of a correctional facility That ranges in scale and that assessment would be done in order to accommodate the results of the ongoing CSG study that I think the results are due in December and As you know this Money is only going to be released once this committee and the joint fiscal committee approves the release of the funds for the assessment so at the last meeting the committee decided to To approve this up with some recommendations and so I put together this this draft So the recommendations are that the committee approves the release of up to two hundred thousand in 2020 capital funds to BGS To commence this assessment of the relative costs and resource requirements for potential construction of the correctional facility that ranges in scale in compliance with the section that I just mentioned in the capital bill For the purposes of the approval there are some definitions and these were handed out Last meeting these were from BGS So resource requirements means the mechanical and administrative services necessary to support a correctional facility with a given number of beds and cost assessments means an estimate of the costs of construction and Excludes land acquisition and includes permitting So the committee would be approving pursuant to your four conditions The first is that BGS would be submitting a draft version of their RS RFP for the assessment to this committee at the August 29th meeting The second is that the assessment would accommodate the results of the CSG study Which is expected to be completed by December 31st the third on The third and fourth relate to the size of the facility So the assessment shall be for a medium security facility and shall include a comparison of no less than three sizes of facilities including fifty one hundred and a hundred and seventy five beds and the last Condition is that the assessment won't be for an eight hundred bed facility I just have one. I think this looks great Clearly number four is meant to exclude a certain possibility The last meeting with BGS was here. They mentioned an eight hundred bed facility This is clearly saying no Yep, and I get that. I'm just wondering because it talks about fifty one hundred and seventy five And then it seems as though You could Look at a seven hundred bed So can we tweak the language? So that's what the committee wants to do More than I think we have to be clear when we're talking about a seven hundred bed or a six hundred bed or an eight hundred bed Are we talking about that as one facility for eight hundred males Or are we talking about a campus style facility where you have a facility of three hundred and four hundred bed facility For males and you have a hundred bed facility for females You have a mental health unit you have booking units That's what gets you up to that hundred bed the eight hundred bed So are you talking about one building that has eight hundred beds? Or are you talking about a campus that has multiple functions? Well, I thought we were talking about replacing a women's facility And I thought that's what it was limited to and if we're not limiting ourselves to the women's facility I don't want to approve this So I think that in the capital bill we had a during discussion and I'm sure the house as well A long debate about the women's facility and the need for improvement and replacement And I thought that this as senator sears has said was targeting that facility And um, we also have the report coming in From council state government. So that's going to that'll weigh in that'll add To the needs and the for what's needed for the women's facility. So I think this looks good. I do have I do think that senator bruce concerned was a good one Hopefully maybe we need to state that That it'd be not more than a hundred or something like that and that it'd be Well, you could say 200 But not more than that the design is to replace the women's facility to make that clear In center, I'm fine with that However, I think that if we And we are we are discussing replacing the women's facility currently We don't talk about the entire system Of what's could have couldn't happen a little I don't think they need to I don't think they need to put a lot of energy into that right now And our committee hasn't even discussed anything Beyond much beyond the replacement of the women's facility but uh I think we But I think if we if we don't Limit this conversation to just one single one facility And not talk about the future of what the entire correctional system could incarcerated system Could look like might be a little short-sighted Which doesn't that go beyond the $200,000 I mean there's going to be it the expenditure here is probably sufficient In that and I don't think anyone must forget Right the rest of the news and I agree that that's that is beyond the $200,000 But I'd hate to turn a blind eye to something that's obvious while we're looking at the spending these these funds for this particular purpose And I don't think the two things are mutually exclusive We could limit this to if it's 200 or 175 that doesn't mean that With this information it couldn't be used to think about a larger system But in terms of this 200,000 and that In favor of the timeline I I agree. I think it should be just limited to replacing the women's facility So I would be happy if it didn't Allow for a more far-ranging expense and And planning exercise So yeah, I just wanted to add that the language for the csg studies says There's some intent language that said the assessment shall inform Infrastructure needs for state correctional facilities. So I think At the time the legislative intent was actually that This would be done to Make that bigger decision about you know, what other infrastructure needs would be required for the system as a whole and then the other point I wanted to make is that Um My understanding and any maybe bgs can weigh in on this is that this is really just looking at Sort of a Just a flake facility of number of beds. It's not meant to be specific I think to women's or some other type of facility because we're not looking at our bgs wouldn't be looking at programming They would just be saying, you know, what permitting is needed for a 200 or 175 bed facility not Um, exactly what programming or other types of things need to be in a facility specifically for women So I think it doesn't My understanding is it doesn't it's um, not necessary to say what the facility would be used for It's really just the number of beds Understood, but I don't think it's a bad idea for the committee to have a clear sense of It's its own intent that's we The ones we have more information from the console state governments that we'll have A better understanding of what we need to do in the future, but for the moment I don't see probably putting a cap on the number of beds so that we're not just kind of scattering funds So Eric bill corn principal assistant to commissioner colt and therefore he's always welcome to overrule me if i'm incorrect But yeah, I think for our exploration Yes, there is a number of beds and different Thresholds of beds need two more burners on the stove in the kitchen and a bigger Power line coming in and a bigger sewer line coming in so as we're looking at these numbers We're really thinking big chunks Scale Yeah, it's just like plugging in A hundred watt light bulb in an album versus a thousand watt hair dryer you might blow a fuse So you want to build capacity to accommodate that growth, you know, we're launching The international space station you get the core module up and then you start adding labs as you go We want to make sure that what we what we plan is able to accommodate Whatever comes, you know, so it could be the 50 bit or it could be the 175 Right, but you know a 50 bed facility is gonna have different Needs in terms of land in terms of water and sewer and in terms of You know just the the the scale of the facility discussions here are going beyond the 175 Which the original discussion That was the original discussion about If you were a place burlington The south burlington facility you needed 175 beds So if you want to put 200 in on time with that, but I thought we were trying to limit it to that discussion And just to tack on to that I don't think it would make sense to say 50 100 200 and leave open the possibility of 500 600 for the designers or the planners We're we're specifying a range for the reason. Okay, so number number four could be no more than That acceptable it's acceptable. I hope it's not short-sighted Plus about this is that Say you can fairly bold step forward as far as legislation says like starting with such a dose The the other plus is by the time we get back here, we should have Studying our hands when we talk about hopefully we'll talk about the entire Incarcerative correction Carcerative population is they will be better informed to continue this discussion In the next session as to what the needs may or may not be going down the highway But this gets us started. This is a kickstart to actually have people start thinking about what's what's on horizon And if we work if we think we're concentrating we hope to concentrate on the replacement the chinden facility That's a that's a great technique So if this I think this money is will be well spent to get this whole process kick started Depending on the information we give back So with the one change is there any other discussion? So what's the what's the new word? Just number four instead of sprites The assessment should give should not be for A facility more for a more than actually it needs to be The assessment shall not be for a facility with more than 200 bed So I want to be clear on this so this we're proving and then it will go before the joint fiscal committee And For bjs to submit a draft version of the rfp at at our meeting on august 29 Joint fiscal can go forward in the interim and allow the money to be released for bjs to start their work All right, that's right. I don't think My understanding was that bjs could not start the rfp until the joint fiscal committee Approved at their meeting Really? I just wanted to be clear that the money if joint fiscal committee approves it Next week or a week and a half the money is then released that bjs does not have to wait until the august 29th meeting for us That's all I want to be clear. The language has said that both committees have to approve For the release of the funds Any further discussion Not all in favor of the amended version say hi hi post All right Thank you Yeah, so we have with us today Susan Lawrence From the national life without world studies To talk to us today about life without world sentencing As a general issue as a race in the united states and history of its implementation and then also How our practice in the united states relates to the international community At large Thank you The welcomes is I believe in Vermont great I reject sometime this spring number 19 people being Will sense the life without world I looked at that number See Of our total population Some of the certainly most meanest crimes In the state Yes, I'm aware. I'm aware of that. Yes So thank you for being here. Thank you for inviting me I'm very appreciative to be able to be here and present this information to the committee So my name is Susan Lawrence I'm from the center for life without world studies and I wanted to start my formal testimony with a brief Multimedia presentation, which is kind of an overview of the topic And so let me start with that My name is dr. Susan Lawrence and I'm a physician and a lawyer and The founder and CEO of the center for life without world studies were based in california And I'm really delighted to be here today to provide you as much information as I can about life without world I want to share a little bit about my background and about how I became involved in this subject So I'm a board certified internist and medical oncologist and had a private practice in california Up until 1992 in 1998 I'm sorry 1988 my husband was diagnosed with AIDS and That really changed a lot of the path of my life He the year before he died in 1993 He made an observation to me that really changed how I how I viewed the world and what he said was You know, Susan he said i'm not dying of AIDS. I'm dying of the delayed effects of child abuse Sonny had used ivy drugs earlier in his life and that's how he contracted AIDS and he came from a Childhood of a lot of physical and emotional abuse And after he said that I viewed the AIDS epidemic in a totally different way That a childhood trauma was the root cause in the driving force of AIDS and of the AIDS epidemic the AIDS crisis After he died I started working with incarcerated teens And I actually saw the same picture with them that they came from backgrounds of Childhood abuse and trauma and instead of being diagnosed with AIDS it was playing out in crime and violence and incarceration So and over time I came to see that childhood abuse and trauma is really the root cause and driving force of many of the most serious problems We have in our society today In 2004 I started teaching a class at the adult prison In which most of my students were serving life without parole The class was called creating a healing society and it was about the impact of childhood trauma on crime and violence and life in prison death in prison And before I started teaching that class I thought that life without parole was a quote humane alternative to lethal injection But my students taught me otherwise Because what I saw is people who had been in prison, you know 2030 sometimes more Years people who were really fully rehabilitated people. I would not hesitate to have as my neighbors Um yet no matter what work they did on themselves No matter how much they tried to make up for the harms that they caused no matter how much They tried to work on themselves They were still going to die in prison and death in a maximum security prison is horrific Um, you know, they have serious health problems. They can't get the care they need. They're separated from their families It's truly horrific. And so I came to see that life without parole is a death sentence of a different kind um, and that informed my decision to Focus on this work So, um, in the next, you know, maybe I don't know 15 20 minutes I'd like to give you just a brief overview of life without parole in the united states The history and some of the socio political factors that have led to the Extreme rise in this kind of sentencing over the past actually like 50 years now so, um The first life without parole sentence was actually imposed To the best of my knowledge and research in 1851 um, a man named william wells was convicted of murder and on the day of his Executions president millard film more commuted his sentence to life without parole Um, and to my knowledge, this is the first time that punishment was was used Wells appealed his sentence. Uh, it went all the way up to the supreme court And the court endorsed elbow life without parole As a valid sentence for the first time However, um, even back then one of the justices could see that life without parole was really no different than the death penalty Justice the glean said an act has been done entirely inconsistent with reprieve As that only suspends the punishment for a fixed period That is it only suspends it until he dies in prison It is a perversion of the facts to say that wells has been reprieved by the president So after that time, it was life without parole was virtually unheard of in the united states um, until 1972 In the firm in versus georgia case, which ended The traditional death penalty because it was arbitrarily and capriciously applied Brought about the unintended consequences of an exceptional rise in extreme sensing including life without parole I know in california Charles manson who wasn't you know, like a shining example of why life without parole is not necessary because he had life with Pulled he went to the parole board 12 times and there was no way he was getting out So the parole board does its job people who are dangerous are going to be kept in prison Whether there's elbow sentence or not, but back in 1972 Manson had been sentenced to death and a once firm in versus georgia was decided Manson had a lot life with parole sentence because there was no elbow in california So california as well as many many other states scrambled to introduce life without parole sentencing to protect the public because people were basically freaked out that These very dangerous people might have the possibility of being released So and this shows this is from the sentencing project. This shows that 20 years after firm in versus georgia from maybe a handful of elbow sentences We have over 12,000 in 1992 In 2003 we have 33,000 and in 2008 over 41,000 Between 2003 and 2016 elbow sentences increased by 59 and The latest statistics available Which are from the year 2016 over 53,000 people are serving life without parole in the united states Also Life without parole is one of the sentences that Are implied with the most racial disparities in the entire criminal justice system So we all know that the criminal justice system is defined by Extreme racial disparities, but these are really most Most evident among people serving life without parole and De facto life without parole, which is it sentences that exceed the human life span have carried out in full So in nine states and they're listed down there African-Americans make up two thirds or more of the people who were serving elbow And among people serving de facto elbow people of color are over 65 percent African-Americans more than 50 percent and latinos nearly 12 percent. So the racial disparities are just exceptionally pronounced in these extreme sentencing situations Then it may seem counter-intuitive To people who haven't thought about the issue very much, but Um, the rise of elbow is inexplicably linked with The the campaign to end lethal injection and other forms of direct execution in this country And the reason for that is And this is true. I you know, I know from direct experience in california as well Many people were working to end the traditional death penalty. They promote elbow and expect they promote it as as a horrific Sentence in which people suffer more than actually being executed They promote it as a reasonable alternative Because they believe the only way that they can end lethal injection is if they give the public An alternative that would ensure that people never left prison no matter what And so this this has um Actually, you know contributed to the rise of life without parole sentences I don't know if you guys are familiar with mike ferrell. He's from california He used to act in mash And he he's a Major player in the death penalty abolitionist movement in california probably nationwide as well But I met him at a conference in 2009 and I said to him, you know Life without parole is the death penalty as well. Just the death penalty of a different type death by incarceration And he said yes, I know that he said and my intention is that once we have ended lethal injection And other forms of direct execution We'll then go back and end elbow Well, it really is a flawed logic because if Um, the death penalty abolitionists have been promoting elbow up as a just sentence Uh, then to go back and say oh well, we were wrong. It's really not a just sentence It's really the death penalty and we need to do away with that too Um, it really harms um later efforts to end life without parole. So this is another situation It's very complicated and intricate, but it plays into why life without parole was so entrenched in our society Then we have the prison industrial complex, which I know everybody is familiar with we have the Geo and core civic. I'm sure you guys are very Familiar with that and many other companies that Make a lot of money from uh, and they're interested Oh, yeah Yeah Yeah, core civic now. Yeah used to be called something That's our cca. That's right So there are all these other, you know companies as well that, you know, provide phone service Packages and other things they have a vested interest in keeping the prison population as High as possible All the time that we've dealt with core civic And gdo No one ever came to the senate judiciary committee And asked for tougher sentences or anything in terms of sentencing policies. Well, that's good to know Never once did they ever ask for any change in Laws regarding criminal events inside I know there's a lot of people who say that they Wasn't that like they may have other states, but never have been Sheriff's senator judiciary all the time that we've been using them Oh, that's that's good to know. We actually have a worse experience with other states than we've had with core civic And I know across the country like you mentioned, you know, it may be Virginia, Pennsylvania Other states where we've had more problems Massachusetts. Well, that was a county. Yeah Franklin County, Massachusetts. So you've had worse experience. Um housing We have so few beds in state that we need to house country's we've been up We've been to 750 out of state. We're now down to around 250. I think We've never had since for a long time, we haven't had the capacity to house all our offenders in state So we've used other states. We've used of course civic and geo group and uh, I will only say I just say that for business position and being a judiciary it's And representatives business chair of the house corrections and institutions committee since that time too Our experience with other states was much worse than the price I know fenders would say that as well Actually, I interviewed a number of offenders I know and Well, I wouldn't trust them Completely I do trust that they're telling me the truth about their conditions. That's good to know But um, you know across the country, I know that they have given A lot of campaign donations, especially to states where I just uh, I want to make that clear Prison guards union that definitely invested interest in keeping the population high Over the past 19 years. They donated over 35 million dollars to political candidates in california Committed to keeping the prison population They are less powerful than they used to be because the number of prisoners or lower and the number Of staff is lower. So they're their views or they have less money But this was a fact in california In the past so the next I'd like to talk a little bit about childhood trauma and elbow A perspective from the adverse childhood experiences study and I'm sure Many of not all of you are very familiar with the adverse childhood experiences study For those who may not be I just wanted to do a very brief overview The study was conducted by the centers for disease control with Kaiser Permanente published in 1998 Nearly 20,000 participants that these were people who were insured by Kaiser So they were middle-class people. It was a particular demographic middle-class people who could afford insurance And the study was focused on health outcomes So it was not focused on crime violence incarceration or or anything like that, but it did find an extraordinarily powerful relationship between Childhood trauma and the leading causes of death in this country So what the what the researchers did is they asked the participants to complete a very simple questionnaire with 10 Different ace factors that call them ace factors And they're listed here Recurrent emotional physical or sexual abuse emotional physical reflect Growing up in a family with an alcoholic or a drug user A family member who went to jail or prison a family member who was mentally ill Families in which the domestic violence with the mother being treated violently growing up with one or no parents So back in 1998 And at the time following that The more subtle forms of trauma that we may be aware of now like attachment trauma were not included in that list And I also want to say that It's not just those factors that constitute childhood trauma Trauma is actually a unique individual experience. So what is traumatic to one person may not be traumatic to somebody else? Um Of an event or ongoing conditions in which the person is the person's ability to cope is overwhelming So, um, and what opal palms one person's ability to cope may not overwhelm someone else Someone else may have more support the temperament may be different. So, um, you just can't you can't Make a blanket statement about what is traumatic for a particular individual As well as disruption of a relationship without repair. So in other words, um, You know a a child who is not protected from abuse by parents That could disrupt the relationship and it's not resolved that in and of itself Can be traumatic So the findings of the a study one one of the findings was that uh, childhood trauma is far more common and was recognized at that time Because um, among the middle class kinds of participants more than half of them had at least one of those listed factors A quarter had two and a sixteenth had four or more And it related, um, again, uh, to health issues even 50 years later Um, and this is kind of an old slide. Fortunately h. I. D. A's is not one of the leading causes of death anymore But what it showed what the a study showed is the more of these factors that people have Be higher their risk for the leading causes of death in this country So from the health standpoint, for example smoking the higher your your a score the more your risk of The higher your risk for smoking which leads to heart disease cancer stroke and chronic love disease And you can see down lower on the list alcoholism and i'd be drugs while Um, at this time there was no study that linked those factors were crime and violence You can intuitively you can see that alcohol alcohol, which we know is a major factor more than 50 percent of the Bible primes and you know drugs as well you can see where You know these ace factors can be linked You know it intuitively anyway to crime violence incarceration life and death in prison So how does this relate to elbow, you know, like I said at the time of the eighth study There was no scientific evidence that shows that childhood trauma is the root cause of Of crime and violence and life and death in prison However, intuitively what I came to see working with elbow prisoners It is one of the clearest examples of the impact of childhood trauma on society. It's like a trauma vortex In 2013, however, the first study and it's a small study of only 151 people Was conducted by the Correctional Service of Canada In collaboration with a with an organization in San Diego called Interest Psychic And that organization provides services to Offenders sex offenders people who are convicted of stalking And also people who are convicted of violent crimes So they published their study and it's one of the handouts that I gave you They published the study in 2013 in the Kaiser Permanente Journal And what it concluded is that childhood trauma childhood adversity is strongly associated with adult criminality And a call for additional studies to be done Which I think would be a great idea So now I just want to take a break from that and share with you really greatly the story of Sam It was one of my clients in California who served in life at that role And he gave me permission to share his story Hoping that it would help to provide a deeper understanding of the role of childhood trauma in LWAP sentencing So um Sam has been in prison for 19 years He um the crime that I've brought about his LWAP sentence occurred when he was 22 And in his family there wasn't it wasn't overt trauma His parent was a lot of strife and conflict between his parents And I think that resulted him in him not receiving the kinds of emotional support and attention that he needed But when he was a child and you see his picture here He was happy. He was on the bathroom on the baseball team. He got awards in school. He was like, you look like Typical, you know happy kid Then when he went to high school in his freshman year one of his best friends was shot to death on campus And a few months later if one of his teammates was stabbed to death in his apartment complex And Sam really did not get support in dealing with the trauma and the grief and the loss You know of these experiences And that wasn't all that happened in his sophomore year He was walking home from school with a friend and his friend's dad and A car full of gang members drove by and his friend's dad was shot to death in front of them And then the final thing was not long before the crime was committed Sam himself was almost killed by a person He thought was his friend who put a gun under his chin and was threatening to kill him And he didn't have anybody that he could talk to about these things that wasn't Counseling or support available to him But it was not long after that time that a friend of the family got released from prison a guy who was a gang involved guy Who Sam gravitated toward because this guy protected him This guy would always his name is julia. He would always tell people to leave sam alone So that caused sam to want to hang around with this guy, which resulted in One horrific night Sam was involved in a crime in which two people were killed. He was the driver. He did not kill anyone, but He was involved in a crime in which two people were killed and he was Arrested as being involved because he was the driver And the prosecution saw the death penalty against him. He took a deal and is now serving life with that So while he was in prison, he had got extensive mental health care. He's participated in a lot of rehabilitative programming Has started a program that trains prisoners to gain construction skills and as an agreement with the outside company to hire and Provide support to released prisoners He facilitates victim offender education groups. He's done a lot A lot of rehabilitative work However, unless something changes unless the governor commutes his sentence, he will die in prison and really, um This kind of sums it up. Uh, and this is one of the articles that I provided for you. Um, james garbino is a Expert witness for murder cases across the country And he stated this the best starting potopsies in dealing with most killers is that they are quote Untreated traumatized children Inhabiting and controlling the dangerous adolescents and adults that stand accused of murder And I have not heard it said more clearly and explicitly So Why should we end life without role? First it's a death sentence death by incarceration, which is imposed with enormous racial disparities It's total deprivation of hope Regardless of the degree of rehabilitation remorse anything a person Can do to make up for the wrongs that they've done It's cruel and inhumane and it's antithetical to principles of restorative justice It's important to to note that ending life without role does not mean that all prisoners will be released Only that they will have the chance to be considered for release and that in and of itself Brings hope and meaning to people's lives And finally studies have documented a very low recidivism rate for convicted murderers and I provided this This report for you about the Ungers. I don't know if many of you are familiar with the the Unger's natural experiment So in 2012 there was a case in Maryland Unger versus Maryland in which People who had been convicted of murder and rape before 1980 their Instructions were found to be unconstitutional so about a little over 180 people were released and Their sentences were were vacated and they were released and they received enhanced reentry support From a I think it's the open society Institute in Baltimore And they received a lot of supporting housing transportation financial support employment And of these I think it was a hundred and eighty five people The precipice rate is less than one percent only one person was re-arrested. I'm not sure what it was for But it documents. It's like a natural experiment. You know it documents that you can release geriatric Prisoners who have served long sentences and who have been it's demonstrated that they have a very low risk for re-offending It's safe to do that and it saves the the government the people the taxpayers a lot of money Um And finally, you know the moral question How do we want to treat the children who now reside in adult bodies the children whom our society has basically failed Who our society has failed to protect from abuse and in fact has inflicted abuse upon How do we want to treat them? Do we want to throw them away like a piece of trash? Or do we want to rehabilitate them as best we can and those who are deemed safe through terms of society? Do we want to give them a chance to do that? and wouldn't be complete to uh to say that the voices of um survivors of family members of victims Need to be included in any conversation to end life without war It doesn't mean that their views are going to take precedence over anyone else's But they need to be respected and heard and also recognize that they're a diverse population. So some victims and and family members of victims may be Very supportive of ending life without war others may feel like no these people need to Die in prison because of what they did. It's a diverse group also family members of people serving life without war all need to be included in this conversation because They committed no problem yet They have lost their family member and they have to deal with the the trauma and agony of Visiting their family member in prison for decades or not, you know, so it's a it's a very complex thing So I thank you very much for inviting me for your attention. I hope this information has been helpful to you and um, I'm happy to answer any questions that you may have Thank you Appreciate it. I do have a copy of the younger's Blackers and County Adverse childhood experiences And adverse childhood experiences and uh, about personality and aces Thank you for all that Um, I have a couple of questions you mentioned And I I got to thinking about Jeffrey Epstein. I guess his name is pretty widely seen He's 66 Let's say he gets a sentence 30 years It'd be 99 He's eligible for parole Isn't that a death sentence? I mean I And people would see that 30 years as being actually not a Long sentence for somebody considering the charges against the guy, right if he's found guilty Obviously we have to presume that he's innocent, but Right. Well, you know, I mean, so how does that fit in? You you had a slide about The fact the fact of life without parole and and Vermont we have The serving sentence is consecutively from time to time So if somebody's given two 40 year sentences and they're run consecutive and even if the person's in their mid-20s, that's 80 years, right? There'd be 105 when they're eligible for parole Well, I guess in certain situations it will end up being like that. Um, and again, yeah So maybe How those kind of situations that because I most of our prosecutors are wonderful people And I'm thinking that, you know, frequently they're You know asked to get People they feel they deserve them Rather than if we ban life without parole when they just go with the executive or try to get a judge to give consent Well, any effort to end life without parole would have to also include ending Any consecutive sentences or anything that could end up in a defect or a rough situation What you were saying about Epstein if somebody connects a crime, you know, they're prosecuted when they're older Um, like in california, because we have, um, So if you're over 60 You would be eligible, but you have to have served 25 years of your sentence. It still hasn't been a time of visiting So if someone is older and they serve a crime that they let say their sentence is 20 years or 25 years for You know, there are going to be those kind of situations Who's going to turn into that, you know, they, um, I, I strongly strongly believe in ending life without parole and the effect of that Well, but there has also has to be a kind of remedy. Um So I have a question. Um, um, situations just Expressed about they get to a certain age and then they'd be Eligible based on Their age they could be in their early 70s late 70s. What if they have some real health issues? Which most of them will Right, and there's no place to place them That's what happens. I mean, what if they need nursing home care? Or what if they need more of an assisted living care? Right, and it's and they don't want the provider Uh has Medicaid room has Medicaid And if they take a person who is still under the custody of corrections, they that provider might lose Medicaid for the whole facility So, how do we address something like that? Well, you know, people who are terminally ill Are so sick that they're not able to think they're with risk of re-offending is really negligible Can be released under a compassionate release program But they're no longer and they're no longer under the jurisdiction of the department of corrections So they may be at least in california. That's how that how that works So they may be eligible for medical we have medical Maybe eligible for medical it can be released to a nursing home If they don't have family it is worth to have so if they have a long sentence That undoes the sentence then Because they would no longer be under the custody of the commissioners right Right Yeah, but they didn't do that they kept them under the custody of the commissioner and we already have medical furlough In our state So a compassionate release as it was presented In the past to us Was the person would still be Under the custody of the commissioner of corrections And that's where you get into that problem Facilities in california their release They can just be released outright depending on their medical condition under the alliance has a question This is a good question for us to consider The as you're talking about aces obviously the Ace that it's not a causal relationship that automatically again, but x number of aces you're going to end up incarcerated No, it's not that but there are consequences to exposure early on and that is the need for support services So as you were are looking at LWAP and thinking about Elimination of that What else is being put in place to ensure that these folks then Can truly have hope that they really do have an opportunity to improve their lives I mean the health care issues then become important That's who's how are those services then being provided whether they're Health care or counseling services. So what is the thinking around that? Well, the I guess the hope is that the savings in releasing people before they get to work When they're elderly and have a lot of health problems um, the savings could be put into the front end for Prevention services and also for re-entry because I'm only the younger study The re-entry services were above and beyond what the average prisoner gets And they believe that that is what relates to why the obscenity was so exceptionally well So and then in terms of where the money came from to do that How did that I would read that study out on that savings from medical care and other cost of incarceration Of elderly people who pose little or no risk to society So it was bed savings, but but it wasn't anything but there wasn't there weren't so it was like We had to save the elderly first. I'm thinking about how can we how can we front load this so that Oh, well getting rid of extreme sentencing. Let's say we have 20 years as the next 20 years to life is the maximum sentence That means we would not have people in there Most people would not be in there for 30 40 50 years The state would not be paying for the maintenance of those people would not be paying for their medical care For their the cost of their incarceration all that savings could go on the front end for prevention And on the back end for reentry services so that the people can become productive taxpayers And contribute positively to the system The victims The victims community been supportive or they've been against you know, it's very diverse You know, some people who have been or victims of crime survivors and family members Support restorative justice support the The opportunity for the people who have caused harm to take accountability But to have an opportunity to rejoin society others don't but I really believe that we can't You know the opinions of one group of people should not form what our criminal justice policies are But they definitely need to be part of the conversation Part of the discussion The restorative justice Yeah You know, there may be people who are who are outraged that there are That someone who murdered their family member now has an opportunity to get out And one of the arguments that they make is that when they when the person was sentenced to elbow It was like a promise to them that they would never have to deal with this trauma again They wouldn't have to go to the world board and protest or anything like that You know, everybody has their their point of view based on their experiences and we can listen With respect we can honor their point of view But when it comes to making decisions about criminal justice policy It really can't be based on individual people's point of view And we're not going to please everybody And the other thing that I wanted to bring up too that I just thought about the other day Is that the family members of the people sentenced to elbow They in a way are victims too. They did not do anything They didn't commit crime And they've lost their family member And they have no hope of their family member ever coming back home It's very difficult in many prisons to visit. They're located far away from urban areas A lot of the families are not well to do. It's very difficult for them to travel The phone calls are very expensive. It's difficult to stay in touch So that they are another effective group that are not often acknowledged I mean, you know, I've heard of victims But I I live in an area of the state which is Has with all due respect to channel three, which is the only station Vermont we can get in Bennington Most of my tv comes from Albany, New York And there have been You know, it's not nightly but Frequently there are cases that are high-profile where somebody's up for parole And, you know, they always interview the victims and how outraged the victims are that they have to be Re-traumatized by going to these parole board meetings To urge the parole board to turn the persons Something's down I just you know, that's one of the things I would expect to hear from victims community about Particularly I gather 19 people There may be some more sense though the time I checked with the department corrections, but I get you know, some of them are pretty horrific crimes Think the one in Danville comes to mind where the teacher was murdered by that couple You're absolutely right. Some of them are very difficult to find This is an issue that we'll come up this year I was still introduced last year and I expect the Senate to help this year So, I You know, that's one of the reasons we asked you to be here As to this committee to get some experience for this issue So it's not going away Freeze up an interesting more of a statement question Conversation about it. It just should move forward within the legislative body We in our committee started talking about Uh, presumptive parole Last year in previous years and had Skating speed How this all fits into presumptive parole. We actually started talking about do we need a parole board? So this could do we what do we do we need a with presumptive parole or we need a parole board or just a person So we that conversation came up also. So this How does should you Kentucky and Maine don't have right? So we started talking about things like that. So how how would this roll into to some of that? So it's an interesting concept and if we did away with parole, yeah Yeah, and and then by during the same conversation How many statuses release status of doing if we do if we have presumptive parole It's just a huge conversation. It's going to take a long time to flesh it out I don't know if we can do it in one session The second piece is I would and I and I appreciate your enthusiasm about savings people that have would have something 20 years to life you could assume that at 20 years They would be eligible for parole and in all likelihood Be paroled with the exception of the outliers like Manson. I would hesitate to build a budget on somebody On the assumption that somebody would be paroled at the end of At their minimum sentence length or whatever. So I that could be part of the conversation, but I wouldn't think it would want to be a very big part of the conversation But thank you Yes Very sorry to have missed your presentation very interested in us. I couldn't be here Just to build a bit on what Which was saying it might be interesting to have a conversation around Rolling restorative practices into whatever we do on the end of a sentence with a relative to parole So rather than the traditional way, I mean to give a voice to victims and other parties in the process And we've got Community justice centers who are already doing that sort of work and maybe there's a way to engage The people who have been hurt by crimes Any other questions Has any state actually done this yet? Ending life without parole. Yeah, not yet, but in pennsylvania. They have two bills. They have a senate bill 942 They have a house bill 135 um that I believe makes 25 to life a maximum sentence last year they Almost the bills almost passed. They had a lot of acquired rights Groups that apparently were not addressed beforehand So the bills are reintroduced this year. They have a lot of support from community advocates. Hopefully they have They're having conversations with victims and survivors and families as well And um, you know, hoping that back to those bills pass And then massachusetts also has legislation in the works But no, no other state has Affirmatively ended life without parole Alaska doesn't have life without parole on its books, but it has um A mandatory 99 year sentence for first degree murder. So it has de facto a lot Um Well, that's very helpful. All right. Um, any other questions? Thank you so much for being here. Thank you for having me. It's been a pleasure Um Maybe we can You both want to come up? Yeah Yeah Human Not And it's pushing the correction system Places So we have two experts Our own Morning everybody good morning everybody Nice to see you in the middle of your life I know yes It's definitely been that we've had a good time of a little bit down time over the last few weeks But still getting prepped already for the next session as well. So, uh, I know it's hard to believe I've already been looking at the draft request for next year I'm sure it's under one I haven't gotten your question solved our mental health system problem Exactly It's a simple job, right We'll fill out the details on Well, uh, I think as you can see from the agenda with Katie and I here to talk about Is the, uh, insanity defense competency to stand trial and the process for addressing Defendants who are subject to Criminal charges and end up raising the either the insanity defense or the competence to stand trial I'm going to talk a little bit about the legal standard and fleshed out as to what it means and Our courts apply it and then sort of transition over to Katie and she's going to talk about more The substance of the process and what happens once the court makes this finding How do the different state agencies that become involved with Has been who's raised one of these defenses or been found incompetent. How does that person get Get treated within the state state system So that's kind of how we decide to divide it out But you know, if you have questions, please jump in at any time as we're talking Even if we may defer to the other one over one question deals more in one subject than the other But that's the initial way that we've sort of partitioned it out between the two of us So I'm going to start as is often helpful to do with the Statement of the law. So what does the law say about the insanity defense and you'll see That it's in title 13 section 4801. There's an entire chapter devoted to the insanity defense that also includes The competency to stand trial issue But I want to talk about really three different concepts when I'm Discussing this and that's the timing The nature of the legal standard and the consequences. So that's kind of the big picture I'm going to go through fairly quickly given our time limit But there's an important before you look at the language even there's an important concept about timing to keep in mind so The insanity defense and competency to stand trial are brought forward at two very different stages of criminal proceeding Right. So the insanity defense has to do with the defense mental state at the time the offense was committed And only at the time the offense was committed Whereas competency to stand trial has to do with the defendants mental state at the time of the trial and only the time of the trial They have absolutely in in that sense chronologically don't have anything to do with the other For example, a person could be Found perfectly sane at the time of the offense But then because of what happened in the interim in the meantime could still be found incompetent to stand trial So they would be potentially having met the competency standard. So they weren't very incompetent But they were perfectly sane At the time the offense was committed so they could still be charged and as we'll see in a minute That has uh that difference Has a big effect on the consequences of the two things that the what would happen to the defendant After either an insanity defense was found successful or after a person was found incompetent to stand trial So that's the time at least to keep in mind sort of where on the spectrum each of these legal issues comes up. So Uh having understood the timing so let's look for a moment at what is the legal standard So you see the language that I think you guys have a written handout as well If you don't it's also up on the screen over here And the the legal standards Defined pretty clearly in subdivision a1 and 40 a1 a person is not responsible for criminal conduct If at the time of such conduct, or that's what we just talked about at the time of such conduct That's the timing as a result of mental disease or defect Let me uh make a little comment about that language As we all know that terminology is archaic and outdated offensive to many people But it's been the statutes for a long time and I think Katie and I are going to have to refer to it in our presentation Because that's what the language is We certainly don't mean any disrespect or Or to be offensive when we use that terminology, but that's what it is And that's what it is not only in Vermont, but throughout the country the federal Insanity offenses of the same language of though in the federal situation is severe and we'll see the defect They added the word severe after The attempt of assassination president raven by john hinkley There was a a modification of the federal law and the added the word severe But still the mental disease of defect criminologies Is throughout the country and all the case law that is developed under it has used that exact same Terminology, so we will hear as well. So the language Provides we've just said at the time of the conduct as a result of mental disease of defect He or she lacks adequate capacity either to appreciate the criminality of his or her conduct So can't understand that your conduct is criminal or conform his or her conduct to the requirements of the law So even if you couldn't understand that it's criminal You lack the ability to act in compliance with the law So you see that there's two elements to that and the courts have been pretty consistent about that two distinct elements That have to be proven first one is the existence of the mental disease or defect. So that's uh point number one That the mental disease or defect exists on the part of the defense and the second element is causation So causation has to be proven. It's not just that you see that you see the language As a result of mental disease or defect. That's a causation requirement So not only does the person have to actually suffer from the mental disease or defect It has to be that disease or defect that causes Their inability to either appreciate the criminality of the conduct or the conformance to the law So Even if they could show that they really did suffer from a mental disease or defect if there wasn't that causal connection between that mental condition And their conduct then that wouldn't be successful in standing in defense. So and the obvious question that comes up next I think is Okay, so that's what has to be proven Who has to prove it and how Well, who the who has to be proven is interesting in the context of a criminal charge because as you all know Generally speaking a criminal offense has to be proven by the prosecution And each element has to be proven beyond reasonable doubt That's the nature of the the requirement when someone is charged with a crime Each element of the offense has to be proven beyond reasonable doubt But this is not an element of the offense. The insanity defense is the defense So you see in subsection b there of the statute Specifically said the defendants shall have the burden of proof in the staff between sandy as an affirmative defense By a preponderance of the end of the end of the Vermont Supreme Court and the u.s. Supreme Court Have all held that it's constitutional as long as it's not an element of the offense for to require the defendant have to be the one who proves That a defense was successful. So Uh, and you see the Vermont Supreme Court case. I actually this is maybe able to notice there's a slight difference I tried to use a different color font for these case these summaries of what the cases have said underneath the statute Are below the statutory language So but the Vermont Supreme Court has said exactly that and sandy is an affirmative defense When the defendant claims it he or she was insane at the time of defense Burn is on the defendant to establish and sandy by preponderance and everybody remembers a preponderance is substantially less than beyond a reasonable doubt Prosecution has to prove all their elements beyond a reasonable doubt so that any reasonable person would agree that this fact was true preponderance is not hearing that that Strenuous the standard is only more likely than not sometimes phrases 51 to 49 percent So that's uh, who has to prove less than make the claim what they have to prove Uh, that's a interesting point here at thought from a 10 circuit case You know an obvious question comes of what's the purpose of the insanity defense? What's what's the reason that we even have this on the books and as the 10 circuit stated Pretty clearly in principle the insanity defense can be traced back through at least a thousand years of british law Perhaps as far back as roman christian and judei kola Reflects the principle that it is unjust to impose criminal sanctions on an actor who was unable at the time Here he or she committed the crime to note either what was being done or that it was wrong And you can see the way that phrase is exactly sort of gets the same two concepts are in the language of the statute Right, so it's unfair unjust. It's a principle of fairness a principle of justice essentially If the defendant at the time the crime is committed They either can't control what they were doing or they don't know that it was wrong And that's the similar to elements that we looked at in the statute of language So Question that comes up. How does the defendant prove it? How do they show that they either have this mental disease effect or that the their Inability to act legally or to understand what they were doing was illegal Existed well expert testimony. It's the way it's generally shown You have to they can't in fact courts are pretty consistently said that For the defendant to take the stand and say I didn't understand what I was doing and I didn't know what was wrong Generally not sufficient. You have to have an expert medical testimony expert psychiatric testimony expert scientific testimony brought in to uh to provide evidence and you can see that the Couple of different case citations I put in here that makes that point pretty clearly Expert medical testimony is generally required to establish both remember both of those elements that I mentioned What are the defendants suffered from a mental disease or defect point number one expert testimony required and two whether that condition Was the cause of the defendant's behavior appreciate the criminality I think that should be of type of of his or her conduct or conform to the requirements of the law So that's the nature of the defense who has to prove it how they prove it what they have to show What if they what if they are successful, what if the defendant successfully is able to show that they were Insane at a time of defense. What's the result of that? That's the consequence you can see what the Webster decisions that in vermont consistently the same throughout the country That's successful insanity defense of assaults at the defendant from criminal responsibility for the death So they're not guilty of the offense They cannot be charged with it again. It's that they're resolved remember think about that timeline I mentioned in the beginning. They are resolved from responsibility permanent That's very different from you'll see in a minute as to the competency to stand trial you cannot charge again the The attempt to bring prosecution for that offense is essentially over If at the time Of the offense correct That's right Not the same as we'll see in a minute for at the time try different different story So Moving on to exactly that the competency to stand trial again. We're now moving further down the timeline, right? We're not talking about the purpose of the defense state of mind at the time of the offense anymore Now we're talking about the defense state of mind or mental condition at the time of the trial and again the statutory language is set out again Although in this case You see it's it's not fleshed out as clearly as it was and being sending defense that's who simply said subsection a Second 4817 person shall not be tried for a criminal offense if he or she's incompetent to stand trial It doesn't define what that means. It just lays out that stand subsection b is really just Need to go through all that language. It's really just saying That if competency is raised then the court has to hold a hearing to determine competency. That's the gist of subsection b Um subsection c is really the consequence that we were just talking about that if you're found incompetent You can later be tried If you're found competent subsequently So again very different than what we just talked about as you're mentioning center series very different than Uh, not guilty of a reason and saying can't be charged again But if you're found incompetent to stand trial You can be treated for a while as long as it may take and perhaps later on down the road further down that That timeline you may be competent to stand trial and you can be brought back into court to face the charge simplest terms The person were intoxicated when they were in court and the judge clearly persons intoxicated They come back to court And they're not intoxicated now. They can stand trial. But when they're intoxicated they couldn't Yeah, sir, but I actually saw somebody talking a rain of day Right Yeah, I think as we look for a second at what that means see right here It would be very consistent with what we just said center series because the courts have defined what competency means It's the first first court notation here to be competent to stand trial a defendant must have and there's two two factors of this Do must have sufficient present ability to consult with his lawyer and with a reasonable degree of rational understanding So you consult your lawyer to understand what the lawyer is telling you and a rational as well as factual understanding of the proceedings against it So whether it's because of an ebriation or a mental condition or whatever it was if you can either Consult with your attorney and understand what's being discussed or understand the nature of the charges against you then you could be found incompetent and Whether it's a day later or five years later. You could be found competent subsequently come back in And face the charge So this next point is just sort of about the purpose again. I mentioned this about Insanity defense as well. What's the purpose of In competency or what's the reasoning rationale behind it? It's generally it's a due process principle So the idea is that to try someone put someone On trial for a criminal charge when they can't consult with their attorney and understand what the attorney is telling them Or they don't understand the nature of the charges against the person That's a violation of due process. That's a violation of I don't sort of An open-ended statement sometimes courts the Supreme Court is referred to due processes It defends our notions of fair plans of substantial justice. So now that you sort of I don't know a way to avoid this being a little bit of subjectivity to that but Certainly the fact that you can't understand what your lawyer is telling you Where you don't understand the nature of the criminal charges against you pretty good grossly agree that that'll be a due process violation Charisma So someone I've just got Scenario where someone has committed a crime And the time they were cognizant of what They did and then they they were serving as a detainee waiting for their court date And they had a progression of Alzheimer's or dementia But at the time of the criminal activity, they were cognizant of what they were doing Two years later the disease has progressed to a point that when they came to stand trial They really would be incompetent to understand what was before that So then they would be deemed incompetent to stand trial Yeah, I think this that's right if they meant that standard And you're right exactly that the condition could have worsened or developed even dismantled for the first time during that meantime So then what happens to that person? That's what we're going to get to next exactly Why isn't that just a real question is So the person's either incompetent to stand trial or are incompetent and saying at the time of the of the commission of the act What do we then do with that that's where I think the The system is is I'm a little confused by and I don't I know we'll get into some of it later But when there's been a very serious crime, obviously it gets the attention of the public But sometimes fairly minor offenses Go unfeeded and the Behavior escalates to a point where the community is upset with the behavior, but yet we're still not solving that behavior And what that makes sense, but that's what I I know that You know, obviously the murders are, you know Just unbelievable What happened in Chittin County in those three cases But on the other hand Look at the number of people who are incarcerated with a mental health issue Who probably shouldn't be there who somehow fall through those cracks and You know in the wrong place And that's the problem for everyone including that individual the victim And then the people that are in our communities who are you know continually Doing minor crimes But real pain and death and they're because That they get thrown into It doesn't make sense if somebody Think the second part is what do we do with them? Yes That'll be part of our bill where we fix the mental health system That's the most frustrating part, I think Doesn't Massachusetts have a civil commitment? Well I'm not sure about that I believe they do I know that We had a witness who was part of the innocence project bills who have been Convicted as a sex offender but refused to admit that he committed the crimes and therefore He couldn't get released until he was either admitted to crimes Or submitted himself to sex offender treatment and they were going to use a civil commitment process on him Or they did use that civil commitment process and he stayed beyond what he should have and then they found the innocent of the crime But he just refused to admit it others others who were innocent I'm sure have you know gone through that to avoid the civil commitment, but I believe Massachusetts does that civil commitment I know there's a number of states that have it. I remember This committee and or at least the judiciary committee is a couple of years in a row discussed in detail I said more proposal in brahman So but you writes in our series that that uh When I transitioned to to the study of civil commitment, I know that peg flurry represented the house judiciary committee I believe that John Campbell part of the state's turning was On the senate side and I believe they the study Recommended against civil commitment. That's right, but that was looking specifically for sex offenders Yes I just have a question about some illegal definitions. Sorry, I don't know I thought we were getting to where we were. You were fixing it. I'm still trying to Listen I'm curious on the the for a person who has Mental disease if they are in treatment and it is treated And therefore it's not manifesting itself. Does that come into that conversation or if I I Have been in treatment and And My behavior fits societal norms. I stopped my treatment. I commit a crime while I'm not being treated am I Can I be found insane because it seems to me the underlying Issue is there, but does treatment come into play? How does that fit with that? I think and it's a it's an issue that has been the subject of a lot of litigation that you might imagine That with respect to the sanity at the time of the offense I'm not sure that whether you have been Taking your medication as you should it comes in as much. It's not as relevant at that point in time It's whether or not you were able to appreciate that what you were doing was Criminal or not or that you couldn't control what you were doing That happened to be that the reason was that you weren't taking my medication That's the way it goes But there's this particular a lot of litigation around well, should you be found competent to stand trial? If you would be competent Exactly, but if you chose not to it's almost like choosing not to be competent and I think there have been a lot of different court decisions on that issue It is a very it is a very Difficult issue you put on the insanity side even though I have been shown to have to be Compliant or it works when I'm in treatment. So I am not insane and I choose to for whatever reasons Not except treatment. I commit a crime that doesn't in therefore at the moment of the crime I am by this definition mentally incompetent Or a mental disease rather Then I have a mental disease end of discussion. I believe that's case But is there a connection between that and services or confinement or whatever so Of course, yes found incompetent to stand trial Do they then get released into the community that's a question where I go Not necessarily that's going to be what Katie A question a little bit back from that. So if a person Is insane at the time of the crime and they've been deemed these Not by reason insanity right and they're absolved of the charges, correct What happens to them? Again, it's exactly which the court will hold hearing to make that exact determination as to whether it's all going to It's all going to turn on whether the person is a danger to themselves or others. Where do they go now? You mean physically If they have to stay in hospital Or are they in correctional facility? Where are they now because this is going on now So if someone has been deemed insane at the time of the offense And they have not been charged Under a current system where they go Where are they well if they're insane at the time of the crime And you said that they are not guilty of the offense and they cannot be charged, right? What happens to them now? So that's what we're going to get into I think there's two questions. One is What if there's no finding in the state of turning drops the charges? I don't even want to go down that road. I just want to turn it down on the side of me. I make a motion that we listen to the kids. So then we have questions we ask them. Okay, all right. Not through the question. So we're back to the question. What do we do now? Okay, um So transitioning What I wanted to cover is how a person has involved in the criminal justice system Would become possibly involuntarily committed under order of hospitalization or in order of non hospitalization And we're going to switch documents here So this is a slow chart of the procedure and the process that somebody would go through So I thought it would be nice for you to have something to look at while I kind of walk you through what's in the statue So the first issue is kind of this initial psychiatric examination that's going to occur So court in which there is a criminal prosecution pending may order the department of mental health to have the defendant examined by a psychiatrist At any time before during or after the trial So long as it's before there's a final judgment When there are four possible different scenarios at play the first Is that the defendant enters of the not guilty and gives notice of intention to rely on insanity defense Or gives notice to introduce expert testimony on a mental disease or defect related to whether the defendant Had a mental state required for the offense charged The second scenario that the issue of mental competence to stand trials raised Third the court believes there's doubt as to the defendant's sanity at the time of alleged defense And fourth the court believes there is doubt as to the defendant's mental competency to be tried for the alleged defense In terms of who can make that motion for the psychiatric examination The court can do that by its own motion The state can do it the defendant can do it an attorney a guardian or another person who's acting on behalf of the defendant So the motion has been made for that psychiatric examination And the court must order a mental health screening to be completed by a designated mental health professional While the defendant is still at the court and there's language in the statute that says if the screening Can not be conducted within two hours from the time of the defendant's parents The court may forego the screeners recommendation But assuming there is a recommendation from a screener the court and the parties Look at that screener's recommendation They look at the court looks at other facts and circumstances including the defendant's observations of the defendant's behavior In the courtroom and if the court finds there are sufficient facts to order an exam It may be ordered and completed in the least restrictive environment So where is that exam conducted? It depends on what the screeners recommendation was So if the screener finds that a person is a person in need of treatment Then that individual would have the examination at a designated inpatient hospital So I'm going to pause there because person in need of treatment Is a is very specific terminology. It's um, it's a term of art and it's defined in statute It's defined in title 18, which is our health title and there's a whole section related to civil commitments And so this language is borrowed from that So a person in need of treatment is defined as a person who has a mental illness And as a result of that mental illness again, there's that causation piece that Eric was referring to His or her capacity to exercise self control Judgment or discretion and the conduct of his or her affairs and social relations is so lessened That he or she poses a danger of harm to himself herself or others and the definition goes on to describe What danger of harm might look like So again, if the screener finds that a person meets this criteria The person is a person in need of In need of treatment Then the person would have the psychiatric examination in an inpatient hospital And at that point the person would be in the caring custody of the department of mental health I'm going to confuse Okay, good. We're going to explain to that person that We need treatment Yep, that's next Yes Okay Sticking with the person who the screener found was a person in need of treatment They're in the hospital having their evaluation Uh, if the psychiatrist at the hospital determines the defendant is not a person in need of treatment Meaning they disagree with the screener's recommendation The commissioner of mental health would release the defendant pursuant to the terms ordered by the court However, the psychiatrist at the hospital Agrees with the screener the person is a person in need of treatment The commissioner of mental health must obtain an appropriate inpatient placement And at some point once the defendant is no longer in need of that hospitalization The defendant would be returned to the court for further appearances unless otherwise specified for the court So that's all um the procedure that happens if the screener's recommendation Was that the person was a person in need of treatment? Now if the screener's recommendation was that the person was not a person in need of treatment That changes where the examination occurs It would occur just go back to the evaluation It doesn't need to possible to 30 days as the time limit That they have to determine And then there's language and the statute for continuance Um, so if the screener finds that the person is not a person in need of treatment Then the evaluation would be held at a correctional facility or it could be held at an outpatient facility There's a motion or sanity evaluation Person says And their lawyer at the person Wants a competency hearing Why would you do a complex hearing we had a correctional assessment? This is not the competency hearing just to be clear. This is before the competency hearing has happened This is the initial psychiatric examination to see if they were insane at the time of the Um at the time of the offense The thing that now this is about competency, but this is not the competency hearing This is just to take an initial Evaluation to see if the person is a person in need of treatment. They have not become guilty No, they're charged. They've been charged. So this is the group that I would argue Is problematic for corrections to be handling Somebody found that some screener. Now, I don't know if screeners are consistent. They're human beings, right? So I guess they make a decision based on something Some screener finds they're a person not in need of treatment. So You go to a correctional facility until you get to psychiatric evaluation Would you get a psych if you're found not to need treatment you don't get a psych You do This is where the problem with detention comes in that's that's a minority. I know But other people detain many of them have significant mental health issues and When we start looking at detention members, we're going to be starting to look at hopefully alternatives to that So you you've got people who are incarcerated Waiting for an evaluation and that group is very difficult for corrections health So when the after the screening takes place and then the evaluation is either at the significant hospital Or the correctional facility Who who who does that evaluation in the designated hospital? It's a psychiatrist working at the hospital in the correctional facility. It is It's a psychiatrist and i'm not sure if it's somebody who's working for the department. Is that The question is it somebody who dmh or do you see it's the mental department of mental health that doesn't at that time So it's a state Hired psychiatrist providing the service In and in the case here it is a service provided by the hospital in each case who is paying for that evaluation dmh or do you see I want to know no in each case So when it goes to the hospital who's paying for it, is it the patient or is it it is the state paying for it And at the corrections facility, it is the state paying for it I'm seeing i'm getting it. I'm getting a friend from the audience But so And then in statute are there specific Criteria and guidelines for their timelines But so there's a timeline here 30 days in the designated hospital Is there a 30 day period within which evaluation is made within the correctional facility? I'm not sure off. Okay. So that's when this opens up that question of of Concurrents, okay But you also have in these cases Don't you also have Psychiatrists hired by the state's attorney On the state and then psychiatrists hired by the defense That are looking at the same case A statute does allow for a defense to hire So you might have to do it in evaluation different reports from different sides, right? So some of it confused Yeah On with what you were just talking about the where the evaluation occurs in the crystal Graph going down the graph the arrow point to the left Now I think we Peggy shared the committee with a letter from the victims of one of the members You know Their frustration Sure with the system. So if the defendant is released on conditions Then they're not they're not detained So they'll be they'll be evaluated at a facility doesn't say what type of facility Why So when we look at the Box it says a screener finds a defendant. It's not a person in need of treatment. So let's describe who that person is at this time So the screener is saying this person Was aware of what he or she was doing and it's not insane. Can you talk about this person is just Looking at whether the person meets criteria whether they meet that definition of person in need of treatment at that moment So they're not looking at just for the trial At that moment is that that's somebody in need of treatment And it's in need of treatment regardless of the insanity at the time of the the offense for the incompetency to stand trial It's a difference. It's a it's a medical standard. Does this person Need treatment The commitment standard At that point is where they'll hurt what to do with the person depending on the legal determination Just to finish the thought here so this person you're just determining whether or not this person is Saying at this time Period they're looking at whether they meet the criteria for treatment for the treatment Part of the criteria for in need of treatment is dangerous over others So I am totally wacky, but I'm not a danger So therefore I could be seen in a designated agency. I might be released on conditions or I might be a detainee If the screener finds that you're not meeting that That's that's that piece that I'm not going somewhere besides an inpatient facility According to statute, it's a designated mental health professional in terms of who that is I think the department would be better able to answer Yes And those of the folks that will not to do this great So I need to back up again So I'll roll back to your comments about detainees is not With the court we we have the the fire on the left Defendants been released on conditions. They're not a detainee would live with that. We're not holding that person Uh incarcerated that person for the evaluation Would be that I don't know people are okay. Well, that's my next question What does the courts Send somebody to a correctional facility that may not need to be a detainee For strictly just getting to get into valuation because they don't have it in the community They don't have enough space in the community. I don't know what the reason would be I mean I think the decision is this person Going to be a detainee or not is one decision and then if they are they're over here, but if they are does does Does the court send somebody to a correctional facility strictly for Straight evaluations because that that is That's what's special on a detainee population just for that. But does the court do that statistically I believe they stay longer On mental health. Yeah, the people that are who can answer that question Jack the department of mental health So if it fails that and they don't meet criteria then they would remain corrections If it fails that if they can meet fail or there's nobody else that the name would go out to the community Then the evaluation would be done in the community So let's typically do not the courts don't send somebody to a correctional facility for this evaluation I know that you can't get in the condition of So I think the courts are looking at the bail right now just just at the bail statutes alone and not in valuation So typically they would not send somebody to can we assume typically they would not send somebody to a correctional facility To be evaluated I think it depends on this year's I don't know the bail statutes I'm off the top of my head, but it depends the court is looking at the bail statutes not Not where the evaluation is going to be But the evaluation statute does permit that Does appear there does appear to permit Under 40 to 15 b the order for examination may provide for an examination at any jail or correctional center Or the state hospital or its accession interest or at such other places the court shall determine after hearing a recommendation by the commission So they're they're being strictly for this evaluation I don't know what they do in practice the language it does appear to do But the court has said that this person needs to be held in a correctional facility While the evaluation is going on Or the court says this person can be released while the evaluation is going on Or the court says this person must go to the hospital for evaluation. So they're those those We have 10 minutes to clear this up But the hearings just said for the court can order a person to be evaluated in right Which was different than what you just said Oh For the purposes of Were there other things that you wanted to also be aware of? Well, we've only done This is all pre this is just before the court has made any any finding about whether or not the person actually was This is just an initial exam All right So we've gone to the point where the person has had that initial exam There are various options as to where that exam may happen After the exam has happened the psychiatrist submits a report to the court And that report also goes to the state's attorney It goes to the respondent's attorney and after receiving the report The court would hold a hearing on whether the person is competent to stand trial Due to mental disease or defect. So this is where the competency hearing is and as eric mentioned earlier A person found incompetent may be tried if upon a subsequent hearing the person is found to have become competent to stand trial so that we already covered So The next piece would be a commitment piece potentially So a hearing is held to determine if a person should be committed to the caring custody of the commissioner of mental health when When there are four different scenarios So first the examining psychiatrist finds that the person was insane at the time of the alleged offense Secondly, the person was found upon a competency hearing to be incompetent to stand trial due to a mental disease or defect Third the person is not indicted by a grand jury by reason of insanity at the time of the alleged offense Or fourth the person is acquitted by reason of insanity at the time of the alleged events so At that point there's a hearing as to commitment And if a court if a court finds that a person again is a person in need of treatment that legal standard Then the person would be admitted to the caring custody of the commissioner of mental health And there are a few different versions of what that might look like There's an order of hospitalization Which is just as it sounds that we also have an order of non hospitalization Which means that that individual is still in the caring custody of the commissioner of mental health But wouldn't necessarily be in a hospital setting. Um, there could be an order that the person is receiving treatment at their designated agency, but they're still considered in the caring custody of the commissioner of mental health And um language and statue is very specific that this order has the same force and effect as a similar order under title 18 The civil commitment title Specific here is that at least 10 days Prior to a proposed discharge of a person Who's committed pursuant to title 13? The commissioner of mental health must give notice to the court and to the state's attorney And there would be a hearing to determine whether the person is no longer a person in need of treatment Meaning no longer in need of Being in the caring custody of the commissioner of mental health And if the court finds the commitment is no longer necessary it would issue In order of discharging the patient from the custody of the department of mental health And that person could be tried to just say If they're confident But they were saying they found that it's saying at the time of the offense that no you can't be retried So I just want to be clear the three boxes at the very bottom They're all under dmh. No, or is it just the non hospitalization order and the order of hospital? Correct. So there's a parallel procedure Um, what about the long one on the left there? So there's a parallel procedure for Um individuals who are committed on the basis of a term determination of intellectual disability So that's separate from the order of hospitalization order of hospitalization And I didn't and I wanted The competency hearing itself to find that it's been not confident that all those things happen Does it matter now if the person actually committed the crime or not? Is a river of binding, you know, that's the person that committed the crime If somebody isn't confident they wouldn't No, I guess the question becomes let's say that the person was actually innocent and didn't commit that crime that they're accused of Is there ever a time when the court determines somebody actually I mean I It was ours. It sounds that may not have been the person who committed the crime. Yeah various cases all over the country where Somebody was actually innocent So the whole thing stops and we stopped searching for the We never proved whether this person actually committed this crime or not Interesting question because the determination of Guilt or innocence wouldn't happen yet because the person was determined and coming there There makes various decisions about what sort of treatment the person should have There hasn't been a resolution on the merits. So it'd be interesting question makes perhaps this afternoon for the practitioner So what would happen in that situation if there was actually a claim of actual innocence? Yeah, let's say the person was actually innocent right got the wrong person and it's happened Yeah And through trial you find the person was not guilty. You wouldn't do that And now the guilty person is out there But I think I think we have to be clear the competency hearing and the whole piece that Katie just went through Is all based on a person in need of treatment or not correct That's the criteria for the person getting treatment and being in the caring custody of the department of mental health And it's this blow job And with the competency hearing is not based on being a person in need of treatment Remember the competency to see what stands here even though That's what I want to be clear. No that hearing is to find whether the person Is competent to stand trial when they can understand the nature of the charges against them whether they can consult Meaningfully with their attorney The person need of treatment issue Katie was describing only comes into play If you find the person was not competent to stand trial or not guilty by reason of insanity Then you have to decide well, what's the appropriate placement of this person? And that's when you decide well, it sort of turns on whether they're a danger to themselves or others, right? And if they are I think the level of Right where the level of treatment is higher the level of Whereas if they're not a danger as you mentioned representative. It could be a person who They may well not understand the nature of the criminal proceeding, but they may not be endangered anybody Well that person Presumably the way it works in practice would be subject to a much lower level of intervention So in this chart, I'm just trying to follow the way the person's physically going to end up So the person has been determined Incompetent to stand trial So the finding is the defendant who is not competent Then there's a hospitalization commitment hearing automatically after that And then the this is all the court the court would then decide If the person goes on an order of hospitalization or an order of non-hospitalization Or the court could decide that the person does not meet the criteria meaning they are not person in need of treatment And that takes back in that the qualifying is person in need of treatment Mm-hmm, so So there are two points on this chart where person in need of treatment standard is at play The first is to determine where the initial psychiatric examination is happening And then the second time it's at play is to determine Whether the person should be admitted to the caring custody of the commissioner of mental health And that would be They were in the caring custody of the commissioner of mental health It would be up to the department of mental health to provide them some treatment So that they would become stabilized and competent to stand trial Maybe maybe So Order of hospitalization 90-day order, where is that person physically housed right now is that in the state hospital? And I would say a designated hospital whether it's the state hospital would be a better question for dmh And where would they be housed if it's a order of non hospitalization? There are various options. They might be in the community. They might be at a secure residential recovery facility You need an order of hospitalization to be immunosexious. Would there many of them being corrections in a directional facility? Not if they're in the custody I believe not if they're in the custody I There's an awkward half way down through here. Okay from the base to dlc Okay Could you clarify that Alice If you're on an order of non hospitalization, you would not be in dlc But in order of non hospitalization On an order of hospitalization No, so you could have been ordered to a hospital, but we don't have a bed so you may be waiting for corrections But generally the order for hospitalization happens quite a while after the president is initially done So they could be waiting It doesn't describe that particular process Describes the treatment Was s Yes Thank you, thank you both for that I knew But Well, the question is who's in charge I mean, is it the judiciary or is it the department of mental health? This kind of both And then there's the patient making decisions for him or herself What do you think? All right, we're going to break the lunch into one class. Sandy has a question before we can break Well, I just want to clarify one thing So we're talking about The insanity defense they started there And your to your handout says that a successful insanity defense absolves the defendant What we what has brought us all to this table is a is a decision not to charge So there is there is That doesn't constitute absolving that anybody When you say absolves you're talking about after a Trial on the insanity defense that the defendant wins Yes We're seeing more and more of those specifically people that either have low IQ and are therefore found not confident or people who Have traumatic brain injuries And have been deemed not confident Those cases are essentially non prosecutable and We victim very vulnerable It leaves our entire community very vulnerable and the families of those people struggle with finding that any sort of resources The people also that are found not confident or insane but due to a mental illness and so they are Qualifiable or you qualify for a order Through the department of mental health or either a non hospitalization or hospitalization Those individuals the disconnect is between The department of mental health and either us or the victims of those crimes in the community So as we've learned recently once an individual is put into the custody of the department of mental health as our laws allow Um everybody else is shut off from that They become a 100 patient of the department of mental health and therefore victims of those crimes are not Given any information about the whereabouts of that person when they might be released if they are released I have a just it happens all the time, but Kind of quick Example that sort of highlights this is I had a case where an individual held a gun to a cop's head and Had an obsession with his cop a word eviction process and eviction process and he was found not competent and was hospitalized hospitalized and The way that this sheriff found out that he was back in the community after several threats to his family and his kids Was him showing back up At his residents So those are the sort of examples of people I think being fully they should be entitled to know when the individual who committed such a An egregious crime on them Is being released back into the community and right now that doesn't happen There's also no way for the state or these victims to know whether a Order is being extended and once once they're in the department of mental health has to be those processes and the Any of those orders go down into family court and so we're not able to get that information either um, and then the kind of final place that I think there's a Significant lacking in our system is individuals who are actually found competent And same but have serious mental health issues that are really the underlying problem for their criminal behavior and that Is likely people there are too high needs for probation to handle But really do not belong in jail We need more longer term Inpatient residential facilities for people with major mental health issues especially ones that are committing violent offenses probation is not designed nor it should be to be caseworkers in the sense that Really dealing with people's underlying mental health issues and the department of corrections certainly isn't and I think that we Have gotten very accustomed as a system to rely on the criminal justice system to Take over for all of these other partner agencies when they don't have the resources they need when One it's not our I don't believe that it's our place. We're not very good at it and it just creates over incarceration and Or people that would get the treatment they need very quickly, but don't actually address the major underlying issues and then I'm sorry almost always great funding in the community I know that like you said david has some Specific ideas for ways that we can improve I think that we went over them. I think that they're all really Doable and important. I would just say that I think in general we need more beds, which is a very obvious answer to the problem I see affidavits from law enforcement officers weekly where they come into contact with somebody who's in the mental health crisis and They bring them to the hospital and they're turned away because the hospital doesn't have any beds The officer then within an hour is putting that person back up back up back up to and they frankly send them eventually With a criminal charge because it has become the only way that we can get a lot of these people's services Which is just it's not fair to the person or the community or certainly to law enforcement I think as I said, there needs to be longer stay options In our state and I also think that there needs to be some Process a little more more public process involved in the discharge of some of the patients that are in the department of mental health custody specifically homicide cases and You know when we have a case where an individual is found to have been insane at the time of the events Even if it's a homicide case the absolute best outcome that we have is a 90 day order For them to be in custody that department of mental health or 90 days Which is wholly inadequate Or homicide cases the department of mental health can then On their own seek to extend that but again, we're shut off from that process and don't know so A suggestion that I know david's going to go into more detail on is to allow for in homicide cases a longer period of hospitalization on those cases So I I don't want to take up so much time without because you guys have I get two questions I appreciate your understanding of disconnects and one of my Going to wait for david to bring it up without letting them think about it while we're sitting You bring up an important point is some of the criminal activities and necessarily to the level Of murder it's a lot of times a quality of life issue where somebody is harassing somebody else and we have you know They weren't incompetent. We'd have all kinds of They'd be in jail or they'd be dealing with this but Because of the 90 day rule because the victim knows nothing about what's happening So if we solve it was you know very serious crime, what about those others? I mean you've had him in chitin county with the guy who threatened the mayor you've got to In beddington county with kaia morris the situation you've got other Similar things where there haven't been charges. I'm not suggesting that he was mentally ill Um, certainly there's been a number of those types of issues around The From my perspective the only cases that should be treated The only time homicide should be treated any differently than a retail theft or Or a disorder of conduct are in the extension of an order After finding the queen insane. So I think those orders should be three years rather than 90 days But it would be my position that the victims of those cases are entitled to the information regarding discharge in all Of those cases in the same way. They are in any given victims information about human house today That we do give them information. Yeah I mean, I don't I think it's pretty similar You know in our family court process, especially with all of the cases going through his book Better now we're dealing with that a lot more and we we are able The section is pretty clear now about what we're able to tell victims and what we're not But we are able to give them something because we cannot give them any information If we didn't have it in these cases Thank you So I You one of your points sort of did that folks that are that are common like that That's some serious kind of health needs And then you need to commit it somewhere So we need more So how do you how do you go from how do you get from the common You look into a mental health bed and what type of bed or do you have any Yeah, that happens a lot so individuals who Are found confident but have major mental health issues are often Ordered either through a screener evaluation They can be ordered to do involuntary treatment where they'll be held as that facility Or as part of agreements often or through Chittenden County is very lucky in that we have a mental health court as well as a drug court and our mental health court is Phenomenal so we can actually through that process as well people that have been found confident But need an extended stay as part of their treatment in mental health court can get beds at Brattleboro tree or some other stay for Still only three to five days at a time and then you kind of go through the same process, but That part if the bed is available is quite easy I'm getting somebody just mentioned three or five days Since that the maximum that they can be I think I think Brattleboro tree allows for a longer amount, but I don't believe they I think it's always less than 20 days Should the legislature consider a longer period of time? If that is a I'm not sure why they picked that time I think that anybody and not just the mental health field but the addiction field would say that three weeks is not long enough to deal with a lot of the underlying issues um, but I I imagine that They believe that that amount is There for a reason and most of the time they then would put them to a step down program. That's less restrictive But I know for a fact there are defendants in chitin county that would Benefit from months in a long-term residential facility with major trauma underlying trauma that is and co-occurring because they've now Developed a substance use disorder on top of that to deal with their underlying trauma that They will never Get over that until they're in a facility I think your answer might be yes, I think Look at that. Yeah, understand what's happening why they've picked that amount of time and yes and you know the insurance aspect was just another part of it a lot of them on Don't have insurance and so they can't afford to go with any of these other places Mary and then Jimmy, um, I want to try to move the agenda along though because we've got a Have any agenda here? Thanks, I well, so you said beds Which teased it out? I think we all hear different things where we hear beds and my interpretation is you're saying an array of opportunities for people with in the mental health system Not in the department of not beds in the department of corrections to them less beds in the department of corrections more in the hospitals and Um We raise a really important issue fairness and justice in my mind To the county as a mental health court. I don't know if any other county has I know of any county has none So that you know, it makes an unequal justice system Well, we do have extremely low population so So It is important to serve the people we have I was going to ask a similar same question That representative Cooper asked and I was a type of facility or suggested a career experience So I think I've got the answer It's mental health facilities of different levels hospital step down So, yeah, I think that and I know that the department corrections is here as well But they are often in a position to try to deal with individuals mental health needs within the facility and Again, we're just not that's not our we're not good at that So it could be a secure facility. It could be a staff secure facility. It could be something more residential And even just you know space within the actual hospitals and but they just Don't have the space right now when who is the state's attorney Have somebody who's Not thinking of saying any defense you have the resources that are necessary to Get us That the defense may have no Really not and Is that The legislature or is that I hope it is The department of state's attorneys from the governor and I I'm asking a question that I knew the answer to but As a member of the appropriations committee, I'm really concerned that When I hear that you don't have the resources to defend the state so to speak I am I feel very strongly that All of the state's attorneys would testify that they do not have the resources they need to hire experts in sanity cases Or competency and they are incredibly expensive and we are often dismissing cases That are lower level cases because we cannot afford to hire an expert on them when the defense has hired an expert of their own How can the defense Is it the public defender or is it the private counselor? I mean if you well see the doctor I can get out of it It's the defendant in the office And if we get a if we get an opinion from a reputable expert from the defense Then we have to weigh whether it's worth us spending thousands of dollars for another opinion that could or could not be the same I would just as a I want to make it clear that that was not the case in the cases I dismissed we had experts we had the resources we needed We just didn't get the answer that we hoped for But in a lot of other cases, that's absolutely happening Other questions Sarah, thank you very much. Thank you so much Um, so I was a little confused in allison, but this will give me a good opportunity to have you and David Caten will join us Yeah, I apologize. I thought I was on one three and I raced back from the state enforcement board meeting and I apologized Thank you Cheryl for coming to get me So we can briefly introduce David and how you ended up Oh my god Are you raking zoner? It's a rotator house, twisted zoner Is twisted zoner so badly that? That's right. Who's the thing? Is that for nobody? Is this a rotator or is it twisted? Oh, so, um, whoever guesses it correctly wins, uh, five dollars Who did something like right to work? Senator Clarkson, Senator Clarkson, how did we end up here? So first of all, I want to thank you all for taking this up I have been in touch with the Dick and Jenny and Alice and all of you Because we have very lively dinner table conversations And I am the only non-lawyer at the dinner table these days and my prosecutor son We were discussing Sarah george's dismissal of these cases and I I I couldn't understand What had happened and it was discouraging to learn That her hand was really forced and that there are no good options for these cases And it was also discouraging to be reminded that vermont hasn't established a secure treatment solution for those who suffer from serious mental illness and who've committed the most horrific of our serious crimes I'm really grateful to Sarah for calling the question on this issue. We need to solve this problem Other states have and in many ways the feds have We're reminded that john hinkley who shot president reagan and uh, jim brady In the 1980s Received secure treatment and was just released in 2016 We have an opportunity I think to reestablish public confidence In this in this aspect of our public safety and mental health systems People want to know that people who commit these serious crimes and who are diagnosed with mental illness Will get secure treatment Not just for 90 days With no public knowledge of what happens right now they go into this big dark hole But uh, they want to know Uh, that they're going to get treatment for several years and they need more transparency in this in this situation We can't be afraid of tackling issues involving our mental health and public safety issues systems I'm not advocating for violating people With mental health challenges privacy rights. I would never do that but in cases involving the most heinous crimes Committed by people with mental illness. We need a solution that guarantees serious secure treatment And more transparency for the public. I hope we can work breaking down these silos from state government and We're figured out a way for the legislature public safety Mental health and corrections to partner effectively to solve this problem I mean if we can do this if we all are growing together Once the stakeholder communities have worked together, uh, and drafted some possible solutions David has some uh, and I'm sure there are others I'm willing to help sponsor with whoever else is interested Legislation that would propose a productive solution to this phony issue Um, I really appreciate sarah for shining a light on this issue and challenging us to solve this problem Well, I wanted to say thank you to senator Clarkson and so that folks understand that The judiciary committees and the health and welfare committees as well as institutions Have been working on this issue now for a number of years And don't care committee I said healthcare committees I've polarized And institutions, but that we have been working on this for many years and I think this is the first Time that the public has become aware Of the need for the work that we've been doing Whether it's in opioid Pre-trial assessment Whether it's medical treatment or mental health treatment and We we look forward to completing the work that we're doing and we thank you for bringing David Cahill and today. It's great. It's okay. Senator. Thank you. Yes. Thank you David Pleasure to be here well We're not going to guess because I don't know it's legal to gamble Well, you know I'll give you a plug for vermont tourism, which is that I've been mountain biking in vermont for about 22 years now Never did this to myself, but to Colorado first trip What that means is you should go to the kingdom trails instead of getting out of play So thanks for hearing me on the issue of insanity I I saw what Season 30 George was going through and my heart really went out to her because I had been in a similar situation and it really is not an issue of individual prosecutorial decisions It's really a systemic issue and I'd also like to point out that On on issues where there's this intersection of the criminal justice system mental health needs and the needs to protect the public there often is An instinct on the part of those in government to engage in the circular firing squad Where now we blame mental health mental health claims corrections corrections claims us and so on and ultimately We don't serve the public in doing so. So I'm not here today to be part of the circular firing squad What I am here today to do is first to go over briefly. I know that Eric already did The current state of the law is I see it as a trial attorney and second to make a proposal because I really think this is an area Where a statutory change is needed and would benefit the public So current law just has applied to individuals who are charged with a homicide A person who is not guilty by reason of insanity of a homicide has been charged Has been found by the jury or the judge if the person elects a trial by judge has been found beyond a reasonable doubt To have actually committed to crime So that person beyond a reasonable doubt did the shooting did the stabbing did the poisoning whatever it is And then the defense proved by preponderance of the evidence That the person is essentially excused from their conduct because they had a mental illness or defect That either rendered them incapable of appreciating the criminal nature of their crime Or rendered them incapable of conforming their conduct to the law The key point here is that insanity is a different animal from incompetence Uh incompetence just means you are not in a position to stand trial because you can't Uh being able to participate in your defense It is less for another day whether you've actually did the crime But when it comes to insane homicide defendants, they actually killed someone There's actually blood on the ground and we should actually care about Um and that's why my proposal today Is narrowed only to the issue of insane homicide defendants Senator Sears you brought up an excellent point In your discussion with states attorney george about Individuals who fall through the cracks, you know an example of an individual who falls through the cracks Is someone who suffers from mental illness and someone in connection with that They're calling 911 day in day out tying up emergency responders When in fact they had no emergency Um that type of person is likely today getting ping-ponged through the system and it's not receiving effective treatment In my view That's an even more difficult problem to solve than the homicide defendants So i'm going to stick with the homicide defendants for now So uh let's talk about what happens with the insane homicide defendants after they are found insane The Proceeding is then confidential So there's no no rays of public sunshine being cast upon this proceeding There's an initial order of hospitalization that lasts for 90 days Upon the issuance of the order the person is no longer the defendant. They are not the patient And that then is really significant because A patient is a person to whom a health care provider has a duty And the health care provider in this instance is going to be the department of mental health We should not blame them for doing their job their job according to the law is To treat the patient as the patient But we as members of the public might expect the law to read differently That this person is more than just a patient They're patient and the public safety risk. They have dual status But in the current law the department of mental health after the 90 day order may apply for continued treatment for up to one year May is discretionary and the key consideration and exercise of that discretion Are the needs of the patient There is some language about public safety that's backdoored into The needs of the patient but the key thing here is that they're the patient and the needs of the patient Are by law to drive the decision regarding whether continued treatment is necessary I bring that point up because A lot of the mental health issues that are insane homicide individuals are experiencing an episodic so They can have a violent mental illness driven outburst Or or event and then appear to be I don't want to say just fine, but appear to be non-homicidal for a substantial period of time Before that homicidal tendency Rear itself again Which is again why considering the needs of the patient alone and problematic because When they're in the non episodic portion of the cycle According to the needs of the patient They should Get kicked out the back door. Maybe get more privileges. Maybe end up on an order of non hospitalization And the key omissions here are any sort of public safety filter any victim notification filter And most important about any transparency Here's my proposal And the proposal is specifically geared to Better reflect our collective values that include the preservation of human life above all else And it is for insane homicide defendants only And in statutes we should give that person dual status We should give we should call them a patient and also a potential public safety risk All hearings regarding public safety should be public In victim notification and by victim I mean not just the survivor of attempted homicide But the statutory victims who are the the family members of someone who is the victim's completed homicide They should be entitled to notice before The person leaves a secure facility for any reason There are myriad reasons why someone can leave a secure facility Could be because they're officially getting stepped down outpatient treatment could be because they're going to the dentist You all have recognized that there's that need for notification on the department of correction side There's that equal need for notification on the mental health side of homicide defendants It's totally lacking. We should put it into a lot Um, also the initial term of commitment right now in 90 days For a lot of people I didn't get you through one cycle of Of bad behavior and good behavior Other states have picked a number I'm going to suggest to you that the number should be in three years Um, if you ask me why three years, mr. Kale, I'd say senator Sears New Hampshire does five New Hampshire does five and I knew you wouldn't give us that So Right, exactly. I'm arguing against myself that yeah, probably was a poor move and uh There should be no ability for the person to leave the secure facility without court review So there's no back door where an entity could opt not to apply for further treatment There's no back door where someone in exercise of their discretion can move the person to On order of non-hospitalation There should be a standardized practice where there's always a court review That includes both the needs of the patient and the needs of public safety And I think it'd be up for you to decide how much you weigh Each of those interests. They are often competing interests. I'm sure senator Clarkson mentioned, uh, mr. Hinkley Who in the early 80s? Well, I I don't personally remember but I hear Uh Took a shot at uh, mr. Brady and president Reagan And uh Clearly they were competing interests at play and making his release decision Granted because it was a case involving president. I'm sure it was treated not as all cases were treated But on the federal side, they had to weigh mr. Hinkley's interest which I'm sure a favorite release some period of time less than 30 years after he did the shooting Against the interests of public safety. It'll be for you to decide how those should be balanced. I'm just suggesting that they should be Lastly there was the issue brought up of resources on the state's attorney side versus the defense general side So the state's attorney George is correct that when it comes to homicide cases we Do what it takes to try to find the resources to match the experts that are on the other side of the aisle When we do that the net effect is that We use up our budget and it's not available for cases that are limited further down the spectrum like your sexual assaults and your birth release And that's just a function of reality of our budget I guess, you know, I'll jump in with a question about aggravated sexual assault Or I would think people would be Very upset if those once, you know One of those cases came up and the person was only 90 days Yeah You know this you know, we have 12 22 crimes that we consider most serious in the state. Why not include all? So One could easily see a path to including felony assaults and sex crimes Um We would be going down the road. I think of the civil commitment discussion that we had regarding sex crimes and It all depends on whether you have an appetite to be hatched a discussion As a prosecutor what I would I like to see that absolutely It's not my ask for you today It's a nice to have it's not a need to have Have you ever had a similar case The attorney george you spoke of Yes, yes, um It was within the last year the defense did you explain how you should have asked the state's attorney george How do you explain that to the Or victim's family? Yeah, in our case, uh, the defense name was our normal cruise He stabbed his girlfriend in the neck And she died If It was it was an all-around horrible experience for everyone For the family to have to experience the crime for the family to see him arranged rocked court And then for the family to get the news that Even the state's expert was not in a position to dispute sanity And it was most difficult for them The the family was not from vermont, so they had no familiarity with our system of justice. It was It was really tough to get to understand the 90-day order And it's something that I hope to never have to repeat again In our instance, the procedural posture was a bit different We we provided the expert opinions to To the judge and the judge issued a verdict Of not guilty of our use of insanity, but the outcome was fundamentally the same as in the chip and cali cases David thank you very much and be careful when you go to Thank you Thank you very much next witness is tj lennerman attorney general Afternoon, how are you? Good. How are you? Thank you for spending time with us in the middle of july Absolutely, I can do it I I think I have a unique perspective on this issue having been A state's attorney and now attorney general will be provided legal counsel to the department mental health and I've come to a conclusion Based on those unique experiences. I'm still confused On this system and I think that's the issue of the day and I want to thank you Senators here in this community for taking this issue up And I can say without reservation that mental illness permeates our criminal justice system It permeates our criminal justice system In fact, I would argue our jails are probably our largest mental health providers and facilities in the state And these are not the cases that are going to rise to the issue of the department mental health These are not going to be the cases that we debate Competency or sanity, but it's mental illness. Nonetheless, senator sears. I want to thank you. I want to thank chair I've seen grad for increasing and supporting the budget for pretrial services which deals with I think that population in the last Three years those numbers have increased dramatically and these folks who are suffering from mental illness are in our criminal justice system A big part of this conversation should be our community health network to different to address these folks That don't rise to inpatient or secure facilities. That's a part of this conversation. That's frankly missing in the last three years FY 17 these are statewide numbers pretrial services assisted a total of 164 people FY 18 387 people through the first six months of FY 19 347 people we think about half of those folks suffer from mental illness This is pushing people out of the criminal justice system back into our community mental health system And I think that's a great thing I want to thank you senator sears for your leadership on that And I think that's a big part of this conversation that we have to acknowledge that mental illness Permiates our entire system. It's not just frankly a small percentage That's going to rise under the definition of a major mental illness competency and sanity So I want to thank you for your leadership And I remember doc They used to do a great report every year the annual facts and failures I used to read it like bedtime reading And I remember talking about the women's Women who were incarcerated in our state 75 percent of them were seen in mental health treatment in jail To make my point about some of our largest facilities dealing with mental illness are our jails And I think we have to look at that when we talk about this issue that it's larger than this population Of the perhaps the acute major mental illness People so thank you for your leadership on pretrial services And when we talk about secure facilities My immediate reaction when we're talking about building new facilities Whether it's a jail or a mental health facility is size matters Because when you build it you got to fill it and when we're talking about the number of evaluations both inpatient And outpatient across the state of romano in the last few years These are not big numbers. That's not to minimize the risk in the issue here But let me give you the numbers in terms of the evaluations statewide over the last three fiscal years FY 17 inpatient evaluations requested 52 FY 17 outpatient 271 outpatient FY 18 inpatient evaluations 50 FY 18 outpatient evaluations 241 and when you break down those numbers and you start looking at who's competent or insane They're saying out of in FY FY 18 inpatient where it's a danger to risk or others which is going to require that inpatient evaluation in the front end Here in the holding cell out of Raymond the judge the defense team are going to make that request 20 not competent 20 insane So I think that's going to frame the debate about facilities and secure facilities are numbers When we look at this issue when I put that out there because I think it's an important part you know reflecting back on My experience as a prosecutor these are these are tough issues and most prosecutors deal with it and competency for me was Always kind of the bigger issue because that's really the gatekeeping approach to the criminal justice system If you're not competent, there's no proceeding. You're not going to go But it's a dynamic it's a dynamic condition You can be not competent one day and you can be competent Next week and the proceedings can go forward and I think that needs to be important. So it's a dynamic Evaluation that can change Insanity is a question of fact and You look at the evidence whether it's an expert opinion or the facts and it's a static analysis. You're looking at a point in time at the time of the crime And applying that standard as sarah and davis can you appreciate the criminality of the conduct and can you conform your behavior to societal norms? And that's really a question of fact and prosecutors We got to make that judgment call based on the evidence in front of them And whether you go in front of a jury or a judge who's they're going to make that determination But it's really a statement of fact. It's not a medical diagnosis And I think that's the point that needs to be made too So I don't have any Solutions or quick answers because I frankly don't think there are any I think one of the solutions or one of the answers Is there always has to be there always has to be better information sharing coordination From prosecutors to the to the department mental health and vice versa because senator as you pointed out There are real victims involved here. They don't care what system Has the offender. They don't care what term they use when you're talking about where somebody has been murdered They want information. They want to know what's going on. I think we will not obligation to do that We have to balance that versus privacy rights, obviously HIPAA But this is this is something where we can we can share information And and improve that coordination. That is something that I support I have a lot of respect for commissure uh squirrel From dmh. I think she's done a wonderful job In her capacity there and a lot of respect for states. It's pretty Georgian state's attorney cable and all the state's attorneys And the problem with these systems is these are systems that complement each other They're not designed to complement each other But the crossover is real and that's our challenge. So I'm here to to listen and I'm here to Be part of the solution and whatever we can do really in that unique role of having the concurrent terminal Jurisdiction but also providing legal counsel to the department mental health I think we're uniquely situated to be part of the solution and I want to thank the committee for taking this one topic up All right, thank you Attorney general There's no question we joked earlier in this morning hearing with Katie and the error that We wanted them to introduce legislation to fix the problem Um, and then you just draft it and that was Anything to hit any of you have if you could get them to Eric and Katie I'm sure there will be legislation introduced in milk bodies this year to try to Deal with the problem though. I'm reminded that we've been trying to deal with this thing for I think ever since I've been here You know when my first term was a horrific murder in bennington for a plant manager, you know, I think about when People have commented on Mass shootings, there was a mass shooting in bennington where Luckily Only one person died and I say only one but a number of people were wounded in the shooting the woman Ended up in the system and has been in the system. I don't know You know for a number of years so my first term I remember trying to tackle this problem Was the definition Of insanity versus incompetence Uh, it seems like we have a basic disconnect between the mental health system And the justice system in terms of what those two rules mean So that's part of You brought up a tremendous point. I think in terms of free trial services other states have county jails And those county jails have been working on what's called a stepping up initiative, which is trying to find alternatives for those who are mentally ill Rather than having them held in statistically Those with mental issues are held longer on detention than the Rest of the Much of it because where else do you what else are we supposed to do with it? I actually had a defense attorney not a state defense attorney, but an defense attorney told me they Recommended them a client. They stay Because there was no super place jail Um, you know, it's just So those are some of the things that we also need to look at I think is but Any ideas you have we'd be happy to hear them and work with eric and katie on the legislation Eric and katie and the ones beside me I have a question. I don't know that you can answer if it goes back to k help what you're talking about Dual status And one partner that is really clear. So the department won't help. Who's the other partner? I'm tk hals proposal Is it the courts? Who's the other partner for dual status dmh is very clear. They're one partner. Who's the other partner? Well So just to be clear what I was proposing was the statute needs to recognize that there are two purposes There's the these are the patient and protection of the public The second question is whether you need two different departments of government to actually administer those two separate considerations Uh, in any way the history of viewing that say the useful offenders where we have the department two of their families and Part of uh corrections both monitoring one individual Can't suggest that's the most efficient use of any of those resources Um So that then needs me to my next slide Where is this person? The patient or the defendant or whatever name you want to give the person Where is that person housed and under whose jurisdiction? Is it a state facility or is it something we contract out of the decimated agency? Let me let me answer that with a legal term Part of this is you have two systems that use it that uses different terminology You're talking about the same problem, but with different terminology and frankly different rights Um, and you have that tension that that exists And you know, I think anytime you can have greater coordination and look, you know from my time at states attorney We would do o and h is quite often the order of non-hospitalization It's side off on it And that's kind of the last year You heard of it and that's not a reflection on dmh It was more of a reflection. I think on the prosecutor at least on me because you said, okay This is now off my desk and I think that's a fundamental change that we have to be willing to say that we all have skin in this game that we can kind of Perhaps redefine and expand a definition of public safety while maintaining or respecting people's privacy rights dmh's roles a health care provider Um, so I think anytime we can have increased and I think we're doing that there needs to be more done And I think frankly some more training Is always helpful. This is confusing and it's and it's I think amplified When you're that prosecutor or the defense attorney And you're in the courtroom and you get 30 pieces ready to go and you get an evaluation coming in your Ordered by the court and it's it is the outpatient is inpatient decisions can be made and you move on to the next case Because that's your job and So I think you know senators you said fall through the cracks. I think that's an issue, but I really want to reiterate the point that Mental illness permeates the entire criminal justice system And it's not just these that we're going to use the term major mental illness. It's everybody And the pretrial services is working that says to me that the courts the defense the prosecutors Are buying into it that this that the numbers That we believe in community mental health treatment And then we have to create a space I think for a limited view based on the numbers Of what we're dealing with but then it's done on a case-by-case basis because for me It's always that issue of competency and then you're looking at the evidence Which is a question of fact on the issue of sanity So if you look at your numbers And inpatient for the evaluations were around 50 20 were deemed not confident that could change the next day. Yes, 20 were deemed insane So you're really talking 20 placements 25 placements, maybe 30 placements Are those physical beds that are stayed on? They could be But I don't know the answer to that question. I want to complicate matters more by Give me in also 18 We had 10 confident but 10 insane And so the question is Were those were those 10 cases? To verdict or was there a resolution and are those 10 people who we said are insane? In doc or they in dmh and that leads to my next question based on competency I would argue they may be in doc got tested That leads to my next question then under whose custody dmh or doc because that determines state hospital Secure residential or correctional facility. Okay, it's going to determine on the order of the court Were they sentenced if they're sentenced they're going to be under doc's custody But if they can't be sentenced because they're insane then it's generally going over the hospitalization side and dmh So it seems to me that Just a statement or Molly couldn't be here But it seems to me that then we're going to be running Dual system Accomplishing the same goal and that doesn't seem to seem like a very productive outcome for Either the patient Inmate or the state Well, I think I think the systems are are fundamentally different the criminal justice system is a public safety system Department of mental health is a is a health care system or a health care provider We have said that they are a mental health provider in this state Are the public's safety ramifications? Yes But that's not dmh's role dmh's role is to determine whether or not somebody is in need of treatment And then what is the level of setting based on that that need in the least restricted You go from being a patient to an inmate And that's a very different expectation In terms of treatment. Yeah I realize the correction Bull is rehabilitation, but what you're considered an inmate while you're incarcerated And if you're in mental health you're considered a patient which says you know Very different You might be in a secure facility You may be in a secure facility, but the focus But the focus is not on your victim There's a certain We put into the corrections model a certain amount of focus on the victim Through restorative justice or whatever processes We notify victims when somebody's released from jail or somebody is gonna You know to have a court appearance or whatever we notify the victim In the mental health system, we give no notice to the victim And that's part of the frustration for many of the victims Is that they have no idea what's happening to the person who Did that either to their family member or to them if they survived the attempted murder or whatever the act was and I don't think that In this day and age That's appropriate. We need to at least I mean hearing about a sheriff Who's being harassed by a particular individual And a sheriff only finding you know Comes home and this person that's at his door It's just unacceptable in this day and age I think it's who's us to try to We may not get I mean, we've been dealing with this for years. It's not like this hasn't been enough Focus, I mean it's a closeout scheme for example We all dealt with that Difficult problem a few years ago Something I guess today But I think we we need to deal with this in the next session of the legislature and I'm appreciative having you know Senator Clarkson bringing this This dining room conversation with Data 20k I'll leave this to this today at least we're at least preparing something ahead of time. So Respective committees get to deal with this. We know what we're talking about Representative Cooper has a question I'll try to figure out if I can frame it as a question And I Very much appreciate you saying look at the data And I'm really do you think we need to look at the data and Allow that to help us inform good policy decision I think it's interesting if I I believe that if you went further back and the data that you've pulled up You will see that there is in fact a pretty big jump in the numbers of Um In both categories so something happened and that's interesting and I think we ought to understand Why there was a change? We need to respond to what's happening today, but we need to understand why it changed So let's be data driven. Um, I also Really appreciate the observation about how mental health issues pervade the entire system and I I said perhaps here is my question of Yeah, we we have a number of issues to resolve Which one do we begin to tackle first? Uh, great question. Um, I would say, you know on the numbers of what happened, I think, you know What we talked about that that pre-trial that mental Mentally ill population that perhaps does arise that major mental illness and the competency and insanity emails I think the way you're looking at you look at the opiate To use a lot of current issues here Where you had the substance abuse disorder and you had a mental illness And because this that they are all linked to go further back You should we should start talking about the issues of trauma and all the I mean This is what the criminal justice system Is not designed to do but is doing and that's why we're in the position. We are not just in remand, but frankly in this nation And so what you do first? I think you have to identify the scope of the problem And I think that's that's the data And that should be that should drive it because I I do have an adverse reaction when we talk about facilities That really should be driven by the light and numbers and numbers and public centers, you're right, you know we DMH is a health care provider And you're gonna have a lot of federal laws like HIPAA that are implicated as a result of that status and the federal funding that Should be addressed. I'm sure commissioner's role will talk about it much more healthily than I can but Understanding that there are public safety implications as a result of how they got there And that I don't have an answer to it and that's going to take a lot of work. I think a lot of I think we got to be really precise while Protecting people's rights, but also making sure That we're sharing the realms of information as best we can So victims understand the status of the situation But I think that it should be data driven and I think that's where I would start and how do we part of that? Oh boy, I don't even know if it's a question, but thank you And identification of the community mental health system is key in managing people's lives It's absolutely important and uh, both the house and the senate have worked on that as well but Mental health regardless of where the individual is is mental health And so we need to ensure that we have appropriate treatment facilities across the board. I think that's what i'm hearing you say and um So any help that you can give us in promoting that then Providing the needs providing what is needed within communities. I think is really critically important I appreciate that and I was reading somewhere and I think after I read where you get the legislature Did the redesign? The mission is correct It is a continuum of care with these two systems that should complement So the intent is there and I think we I think we did the framework Because it isn't exactly the continuum of care from the community To corrections to pre-trial services looking in the community To dlc and jail beds and to secure facilities with dmh and now we're just going to make sure that we have that Compliment that all the puzzle pieces are actually fitting together But I think really again the legislature put us on the right path to do it And now we're going to just kind of put all the pieces together, but it's the continuum of care Thank you. Thank you senator me Thank you for having me First I'd like to say that These I agree with much of what was has been said Really can't disagree with much that A g donovan had to say during the course of extra money We run into the same clientele I'm looking at them from Different different points in the justice system And ultimately the crossover between the justice system and the mental health system Is one that actually has been pretty well defined over a long period of time But it's only when you have unique situations that arise whether it is incidents of three cases being Dismissed or some particularly heinous crime that people decided you're going to take notice And you know I have been in this working in the system for over 31 years and As defender general for the last 18 But I've had a lot of experience working on the criminal justice side with exactly the clients that You're talking about and senator sears brought up The tea case from from then That's the individual who was then In the mental health system since the day of her Her since she's been taken into custody because the mental health system has determined and continues to review Um and determines that she's a danger to herself or others And uh and is doing it just as the statute requires The thing that I think is unique about This situation that that's brought us all here the three dismissals that Is attorney george appropriately Submitted and I think ethically had no choice but to submit Um is that they all came at once on the heels of the case The vergoni days that was still pending general comment particularly about but that also Had mental health significant mental health implications With it. So it's it became part of the public mindset in a very serious case With three other cases that were You know essentially resolved Shortly thereafter and has brought attention to the issue But these types of cases go on in the criminal justice system all the time All over the state state's attorney kato talked about his situation with the case there and I've Had handled many of these myself when I was litigating I don't see the system as particularly broken As far as the analysis of what people belong in the mental health system and what people belong in the criminal justice system The biggest issue really for me has to do with placement issues Once determinations are made do we have the resources and Available beds or other whether what level of security there are they're there is available to keep them Consistent with what they're What they're what their needs are from a from a mental health standpoint? I also think that one of the issues and I'm willing to suggest that We get into the private Mental health diagnosis of individuals who are in the department mental health custody But there's clearly a lack of understanding of what goes on Otherwise the furor wouldn't be so great And There are times when the lack of transparency comes at the expense of the client and That to me might be a way that some of these beers can be a leg Going forward I don't see fundamental issues with the way the system works And I'd be happy to answer any questions that anybody has What you said You believe that state attorney george's actions for ethically and The only choice that she had both I don't know what more to legally and ethically legally and ethically Is that a But that outcome What happens to those individuals those are individuals who go into the mental health system And they have to continue to review over a period of time just as in the tea case as to whether or not they Have major mental illnesses and are in danger themselves or others and they have provided treatment As necessary and they have legal representation through Legal aid for any of the issues that arise in that part of the system But it was a good tea but She had 91 or 92 But I don't think she was ever Came to a trial situation Correct And those are those are cases where you can be incompetent and insane. You're insane. You're incompetent because you're insane. Yeah and you're unable to Participate in your own defense because of your major mental illness and the result once you are In that case a hospitalization order is to have that continuing review until you're deemed able to not have So it's possible that the people in the chitin case this could be In the system for a long period. It's absolutely It's also possible. They can be out 90 days theoretically, yes But you know those are that's the evaluations of the people you have working in mental health I mean, I think it would be highly unlikely that people are going to be watching at the door in 90 days But Theoretically it's possible What about some of those other cases going on? I asked Say that you're okay. You know about the cases that don't like to that one and that many of you may not even know who they are Whatever reason they they end up in my health system on the correction system there back all you know yelling calling 911 I mean, I have a case of A That was this guy making noise every time he turned around That he got charged with his partner's car alarm every You know try to come back to voice the other guy. Yeah Well, you know, they're all they're all increased mental illness and the standard is you have a major mental illness and are you are Are you a Danger to yourself or others once you get to the point of hospitalization or not hospitalization Obviously, someone's starting tonight exactly the Danger to others even though there are no instances that those are things that you know when you when you live in the world You have to deal You know, you can't anybody by the way, whether this is whether it's a homicide case or a false alarm case Has to understand that These folks Are always in our system You know, they're either in the criminal justice system doing it or they're out of the christmas And there's a range of them from car alarms to homicide people who have who are mentally ill permeate all parts of our life And you know, there has to be some recognition That we aren't going to respond the same way to all of them the same Do you have Do you have any idea how many beds we need in the mental health system? No, no, no, I have no idea what's going on You know once they once we they have a hospitalization or non-hospitalization work Then the defender general's office is done with the case. So Do you have an opinion? Yeah, I do. I think it is important to know like as defense attorneys We are often trying to facilitate getting our clients into mental health beds And it is often frustrating that there are not enough. So I can't tell you how many but I can tell you more For you more Thank you I think you need to be clear You're saying what happened there because I think everybody goes level one acuity and that's not what we need We need step down fits I think that's an important part of it. I mean this whole discussion gets framed around the most traumatic cases That's not the bulk of the work that the system does the work of the work that the system does Is not dealing with the murders the bulk of the work that the system does Is dealing with the much lower level offenses that still have that those mental health problems associated with If all is not a resource question, you may ask Oh, it's not going to be a problem Let's hope that somebody asks you a resource question I'm trying to prove That's a little between the property and the data We'll have that argument some other time Subjectively, buddy Did you have a question? Yes, and I'm asking you because I don't I could have asked anybody else because almost everybody Is raised it and I don't think anybody really has the kind of jurisdiction here But we've talked about The need to have transparency and to shine light and to allow the victims to know and have insight into what's going on at the same time This state has and I'm very proud of the role that we have played in saying Mental health issues are just a component of health issues And that we should treat mental health issues just the same way we treat physical health issues So how do we reconcile that? Privacy issue that we insist upon for physical health With the issues that are being raised here and and and I don't want to lose that I guess now I'm saying my colleagues I don't want to lose that value. It's a very very important value that we've fought hard for So how do we reconcile that? You know, there was something that I was thinking a little bit about that issue and coming in because I One of the things I think defense council always likes to do is to try to educate the public About what's going on why it's going on and then they're less fearful of the process the result and Get a better understanding of what what is going on as a as a fair thing and something with the laws being applied One of the areas of the law that we Do this kind of hybrid sort of privacy issues with strict Sort of categories involved in the juvenile system Where victims do understand what's going on through their perpetrator, but By the same token, they're bound by the law that it's a crime to disclose Um the information From a juvenile proceeding outside of that. So you're serving an interest of the victim and you're also Maintaining the appropriate confidentiality of proceeding that should remain confidential now in that case It's a juvenile case and in these cases it would be mental health or or by the light and So we do this in the law and But anybody who's looking for You know 100 percent or zero failure in a system Should not be to get any of our systems or anybody else They're going to be they're going to be slips because people are administering them, but the juvenile system is one that When you're looking at sort of hybrid notification with safeguards Is one that may satisfy some of those interests Okay, that was a Again a similar question So if I'm a victim and this the perpetrator is now in the mental health system And I call up and say has someone so been released from Treatment in my life to know that at this point. Yes, I believe not But I actually would ask uh Jack McCuller When he comes up So then the other the other question is it's kind of refreshing because you're agreeing with um the prosecutor Uh About the need for additional facilities for treatment and and we do work very closely I think we have a couple reports coming in from our um that will include Information from our designated agencies in our community service needs But what we really need to know is what level of treatment is required within the doc itself Because when I hear things like Seriously functionally impaired, I don't know what that means. Oh, that's a different I understand that It's the total difference to get services within doc We have a lot more to talk about Can you talk about that other time? Yes, we can Yes Anyway, I would thank you Both of you, thank you very much for being here The next witness is uh Serious for a commissioner department mental health I wonder if a commissioner to chef wants to come up because a lot of the questions may be for the two departments And uh, if I could jump camp before the leaves I have a message for you Yeah I'm happy Appreciate this But I think the questions really do relate to those departments Great, thank you. Uh, well, thank you for the opportunity to speak today Serious coral commissioner of the department of health and everyone who interviews themselves in the library I'd like to show commissioner for rations morning thoughts deputy commissioner Any remission no addictions mental health systems director Yes So we provided some written testimony that I hope will be helpful for you as you grapple with some of these opportunities and challenges that we face as a system We're going to talk a little bit about the role and authority of the department of mental health The federal regulations that we must comply with To ensure our Medicaid funding Talk a little bit about discharge decision making and transitions to lower the levels of care And what we as the department of mental health See as potential opportunities And solutions as we go forward and that will be told and happy to answer any questions that you all might have So I think first and foremost And I appreciate those that have testified before us have really underscored the need for partnership and collaboration We see our community justice system department for corrections as key partners in this work And the department of mental health It's important to note. We are a health care provider and payer of health care services And I visit our purview and what we are responsible for Is to provide mental health services and treatment To those in our care and to provide that care in the least restrictive settings And I think these current activities in the conversation that we're having You know really highlights the intersection of criminal justice and mental health is very very complex And when we think about public safety, of course, it's something that fundamentally we value As a department, but the tools that we have Within our capacity as a health care provider are very limited when it comes to ensuring public safety Another piece that I want to just note is that we're all aware that tropical storm Irene in 2011 And a center for destruction from state hospital Prompted the legislature to really create a new vision for our remote mental health system of care One of the core tenets of that system as articulated in act 79 Is that individuals should receive that care in the least restrictive setting And every day that I've driven to work I see the old smokestacks from the romant state hospital and reminded of our old system Where we had a decertified state hospital that did not receive Medicaid funding And people were institutionalized for long periods of time That is not the current system that we're in today And that is a good thing for the owners It's also important to note that the department of mental health we have to comply With state and federal regulations in order to provide mental health services and to maintain federal funding So our remote psychiatric care hospital currently is a state-of-the-art acute care hospital Designed to treat and assess and provide mental health treatment To those who are experiencing a mental health crisis So for any patients that are accessing care at the brought psychiatric care hospital given that is designed to Treat in terms of acuity Even for those who are criminally court involved. It's not a question of if They're going to return to the community. It's really a question of when And so any expectation or assertion that we can house individuals indefinitely in our mental health facilities or programs given the Medicaid funding that we utilize Would run counter to the charge that we take very seriously Which is to serve people in the least restrictive settings and would essentially put all of our federal funding at risk So one of the things that we think about is that one patients are stabilized Within whether it's vpch or one of our stated level one hospitals that probably retreat for Rutland Regional Medical Center And there's a very stabilized and there's at least a less restricted setting that's appropriate to their need They no longer meet acute care criteria We are required to start thinking about transitioning them to a lower level of care Um, we risk all federal funding as a state We don't comply with this regulation And we've had a lot of questions about Discharged decision-making, you know as we look to you know discharge from a hospital An acute level of care and I think what is important to note Is that it is always the unique mental health treatment needs of each individual that drive what treatment they receive Where they receive it and how long they receive it for So discharge from a hospital is a clinical decision based on that No, no longer needing hospital level care criteria And I think it was referenced earlier that there might be some time frames related to the retreat and how long they can Have folks those time frames don't exist. It's based on clinical mental health And once an individual no longer needs that mental health treatment or doesn't need that acute level of care We that work to transition them to a lower level of care It's also important to remember that when we talk about discharging someone from the acute care hospital They can still remain under the care and custody of the commissioner of mental health Through an order of non hospitalization What we've talked about It's important to note that an order of non hospitalization Is related to addressing The issues related to your mental illness. So when we're looking at risk when we're looking at dangerousness to self or others It relates directly back To your mental illness An order of non hospitalization is really to encourage and facilitate compliance with your mental health treatment Whether that's in a community residence statistically secure residential programming that we have One of our intensive residential settings a staff secure residential setting or in the community So as a tool to ensure compliance related to your mental health treatment It's not a great tool to ensure public safety In terms of assessing risk Another thing I think it's important that we step back and consider Is that mental health treatment cannot mitigate all risk? so Mental health treatment cannot address underlying criminogenic Anti-social behaviors. Those are dynamic factors that are best Managed by other kinds of programming and examples of this include substance use impulse control anger management issues history of behavior Including domestic violence So when we think about an order of non hospitalization when we think about acute levels of treatment And when we're evaluating dangerousness of self to others, we're looking at in the context of your mental illness We can provide incredible treatment to your acute mental illness. You could still be a danger Due to other reasons And then there's been a lot of conversations about public health information And I appreciate mr. Cacow kind of underscoring That the department of mental health as a health care provider and payer We have to adhere to laws That govern protected health information So as such Because we have patients in our care as a health care provider We're prohibited from disclosing information about patients So we can't even confirm or deny That someone is in our custody And that's HIPAA protective information And it's my understanding that Vermont law cannot override federal law So that's something that we need to think thoughtfully about is we think about this challenge of Notification and recognizing that we are operating under federal protected health information Then there is no general HIPAA exemption that would allow the department of mental health to notify people in the event of discharge from custody Or a change in their treatment plan, you know, that's all in your notes. You'll see that I've kind of underscored What protected health information is by definition And that includes diagnoses treatment information medical test results prescription information And would certainly apply to discharge status Can I ask a little quick question? So even if it is court order for the individual through They're still can't Well, there is an initial court order The only thing I would say is that within the initial 90 day court order, so if someone is coming Into our system Charge with the crime they need to be screened for competency or insanity There's that 90 day initial court order that isn't within the court. If we were to discharge There is a discharge here in the choir Within that first 90 days, is that correct? Yeah, there can be. But that first 90 day order Frequently often not always, but we'll have a discharge notice during requirement Or at least a notification requirement And so we provide those during that initial part, but once it goes into those subsequent hearings, it's a family court That's one of the notifications So it's a great question and it's my understanding that Vermont law can Be more restrictive than federal law, but we can't be less restrictive than federal law So that's just something else that we'll have to consider And then when we think about the opportunities or the crack of opportunity That this discussion has brought I think it really is a time We've heard some suggestions where we can come together And think about an opportunity for Vermont to have more of a true forensic system of care And psychiatric care for those who are in various stages of the criminal justice system is commonly called forensic care And one might say that Vermont is a little bit of an outlier nationally in regards to not having a forensic system of care Other states have some examples of that Which do articulate more partnership Between their respective department of mental health, the criminal justice system And corrections Some of those systems often include competency restoration programs more formally. There is also an example That Connecticut instituted the Connecticut psychiatric security review board So they essentially established an administrative psychiatric security review board to monitor the post verdict disposition of defendants Found that guilty by reason of insanity. This was prompted by public concern and procedures for follow-up of insanity complaints So other states have grappled with this have come up with potential Solutions Very well affecting resources from the critical problem Yes, I would assume so We would have to research that more And that board is comprised of appointees by the government that have expertise in law probation and parole psychology psychiatry Victim services and someone who's there to represent the interests of the general public So I put these out here as as opportunities. There have also been some suggestions that Would lead to thinking about From dual custody If you're really thinking about the limitations of our mental health system as health care providers wanting more information That's going to be enormously challenging for us And that federal requirement won't change Could you think about you know dual custody with involved corrections possibly these are all ideas I think that we can be thinking about As a system, but of course would require much more robust research And discussion and I think that Connecticut did find in the research that I did on looking at their program That the regular review of the equity progress and intensive community supervision They feel have resulted in a high level Of accountability So I do think there's an opportunity for a robust policy discussion right now. I think the department of mental health is willing To be a leader and convening partners to think about that discussion across sectors To kind of review existing models of the funds existed about care And to make recommendations about what Vermont could potentially think you think about Implementing and I do think we can use this opportunity to kind of move forward with positive change for Vermont One thing that I've learned in my work is this kind of systems change Systems change because of the speed of trust and you all can't legislate trust That's up to us systems partners to really commit to work together On this Yeah, a couple things I want to mention One is that the Department of Corrections much like Department of Mental Health or the other health institution providing direct care for an individual that's under the same Uh, rules that are in regards to protective health information So in the corrections case, we have let's say we have an individual who is requiring Either a mental health officer to care outside of the correction facility We who will notify the victim That the person hasn't moved out of the facility but we can specifically say Why they have left and where they're going It's important also to know that the Department of Corrections does not notify every victim What we do is an opt-in or opt-out situation In addition says I don't wish to know about any movement or any further actual in this case Then you will respect that decision and we don't make notifications and I think it's important distinction That the committee needs to be aware of The same rules however applied for the for any medical Treatment that's provided to a person who is in the Department of Corrections custody as they would in any other Treatment provided health care treatment provider Whether it be in the state or in the community And so I think those were some of our challenges are we we are big and navigate service struggle them We have to have a conversation with the victim who wants to be notified And the person that's going out to get care It's a difficult those are difficult and tricky waters to navigate to try and Give the victim peace of mind that the person is still in custody that they're safe and secure but we can't specifically give them instruction Or information about what's happening with the case and so there's some anxiety goes along without symptoms And our victims advocate through a tremendous job of doing of working with the victims to Help them navigate through that You want to go back to something that the attorney general mentioned about Pervasiveness of mental health in the judicial system is absolutely right And in our own system About 60 percent of the person that are care are receiving some form of mental health treatment Um, it would be very clear though. That's not a huge mental health treatment That's a very small that's much smaller percentage of people who are Um, acutely mentally ill actively mentally ill Um, in many cases the person may be uh may have a long history of depression But it's being managed and part of that management is through routine contact with mental health providers And those are captured and there are numbers of that 60 percent And in some of the in many of these cases the while they may have been an existing or persistent mental health issue Um, it's not always a good indicator that it was in any way associated with the criminal act itself And I think that's what we see from our population even in institutional behavior and part of our Our process Now is to evaluate a person who has a mental illness Is their mental illness Contribute towards the behavior that we saw from an institutional I'll talk about a couple of behavior, talking about the institutional behavior And that is back to then to how we would manage that behavior too Uh, but it's not often quite frankly that uh That a person's mental health is overwhelmingly The cause of the behavior from at least from our perspective institutional One of your statements that arose from the Berlin situation that I think The public may have taken And maybe I'm not understanding the two On page three of your testimony the purpose of an inpatient unit is not to assure a public safety Then you say it's important to remember that if someone to be involuntary and testing the inmates for their danger to self-brothers Must be resolved to dangers of mental illness I'm not sure what those things mean and then How they relate to each other so If somebody is a danger themselves or others But it's not because of mental illness They're at least Even though there's still a danger of themselves or others Well, I think what uh, what and it's not your role to protect public safety. I guess there's a confusion there On my part, I think as I read some of the public comments to the To the story and the media So we see our role In treating Providing clinical treatment healthcare treatment to someone who has an acute mental illness We see that as our role we recognize That there may be aspects of their mental illness that have caused them Or related to Dangerous action activities that are dangerous. I mean we see our responsibility To treat that mental illness Which essentially you could say Is An effort to ensure public safety, but that's not how we're thinking about it. We're thinking about it from a treatment perspective One thing that's important to remember that when we think about an acute care facility There's acuity to mental illness that we're evaluating from a treatment perspective So you may have Committed a crime Related to your mental illness. We have advanced significantly in our mental health treatment overall as a nation as a state We can treat that acute mental illness And stabilize you And at that point related to kind of our act 79 Our rules and regulations for the centers for medicated medicated services at that point We really need to be thinking about lower levels of care And that would be potentially discharging from a very restrictive acute care hospital To a step down program such as a secure Visibly secure residential program an intensive residential program Perhaps a staff secure residential program or the array of services that we have available If there is a parliament of important safety, right, I mean I I'm having a hard time understanding what's So when we are evaluating the person has a fixation on killing his mother and you know You're keeping these in a facility because he has that Goal in mind You wouldn't release him We are evaluating dangerousness to self or others related Yes, and I think the the point that I think the commissioner is trying to make is that If the assessment is someone someone's fixation on their mother as your example senator That fixation is being driven by a delusional thought process Then our thinking is geez there might be some danger here this person may need to remain in the hospital And so the end result is some public safety, but that's not that's not how we're looking at as a treatment perspective If there's If the if the assessment is that their risk is not due to the mental illness Let's say due to a head injury due to developmental disability due to other factors You know antisocial behaviors and other things of that sort Then we start seeing your premiums any behaviors or other things of that sort Then we have to look at well a hospital is not the appropriate place for that person And we are not in a in the capacity to be able to Hold them for any period of time Because then that that's again back to putting a risk of all of our That's a really great question. Are they competent to stand trial at that point? Well, they might have been competent We can talk about all these kind of different kind of permutations Yeah, I can see People not The crime isn't necessarily the crime that brought them to the attention of the authorities is not necessarily the danger I reckon it was when I ran a group home for a building in kitchen. I had a pillow And the pillow had a little hole in it And we didn't fix the little hole and all of a sudden the pillow was no longer of any use because the hole became huge as they expect at it You know, that's we don't deal with the little stuff. The big stuff will get you And I guess that's what my concerns here That's one concern another question. I know we're limited on time, but I'm confused. We were given this chart and hopefully it's correct So if the screen this is where the court ordered the psychiatric examination based on the screener's recommendation This is from legislative counsel. Okay, this is for the senator Right. Okay. Oh, great. Thank you. The screen defines the defendants for the improvements and evaluation of designated hospital 30 days psychiatric evaluation With the court If the screen defines the defendants not a person who needs treatment Then the evaluations at an outpatient facility if the defendant is released on convenience Or evaluation of correctional facility. And I guess my question is The person was found not need to treatment. They go to a correctional facility Where they're held Possibly for a lengthy period of time because they don't need treatment But if they need treatment, they don't need inpatient treatments. They don't need inpatient treatment Important. I'm very How did we set up this kind of a conundrum where? That that's confusing to me is that we we actually set that up So the guy that doesn't need treatment goes to jail And it's held in jail for whatever period of time it gets to get the evaluation done Which I'm sure is not easy to get enough psychiatric evaluation. I know I don't know I mean how hard it is to stay in jail. Is this contributing to your detention population? Overall, it's a very small percentage quite frankly. I think there are cases that That could come in I think and as I briefly discussed it takes lots for ourselves about two weeks ago Where there is The core has Evaluation and has determined that there's further evaluations required about the department of mental health to determine What if any level of treatment to the department of mental health is appropriate In some cases, this is what we see in this chart here is if they have now been evaluated by the department of mental health And they don't need The level of treatment that's provided to the department of mental health. Yes, they would come back to us Now that you want to receive mental health treatment with the department of corrections What they won't receive is hospital water care and treatment Because what happens there's they haven't been found guilty, right? Well, if you're not needed treatment you go to a jail if you're needing treatment you go to that doesn't make sense Sorry, maybe I'm missing something if they don't meet hospital This is an evaluation for hospital level treatment And so the hospital Psychiatrists determine that they don't need that level of treatment Well, I bet you've been from Dorset for a long time. I'm using my own district I'm Dorset. I probably go to my hospital. I'm from Bennington. I probably go to the hospital for jail I don't understand I'm not very nice. I'm a psychiatrist. I'm going to get me out for the time I don't know It's not a Dorset When you don't take a psychiatrist I wasn't here for this morning, but I'll do it quick You run down someone comes into court State's attorney, public defender, judge, court clerk, someone has concern about someone's mental health in the court system They have to call a dismaying agency to have a screener come in And basically if a screener is not ready within two hours, they can make their own determination But basically screener comes in and they will make an assessment and recommendation to the court should this evaluation for competency or sanity occur in an inpatient setting or in an outpatient setting At that point if the order if the recommendation is inpatient judge orders inpatient evaluation And then they will be transferred And from there they're assessed by a psychiatrist to determine to make a second determination Does this person actually need hospital level of care? The screener made that first recommendation. They're a qualified mental health professional But they're not a psychiatrist And so now the psychiatrist will make a second determination and go yes This person does need to be in the hospital and thus They're admitted to a hospital or no in fact they do not need hospital level of care And then at that point if there is still bail they will be returned to corrections if there is not bail They will be released into the community where they will have their evaluation done And they'll be released on it and club once they're released into the community. They're not in our custody They're they're out they're on their their little cognizance and they will be you know receiving their outpatient evaluation And that's a 30 day period within that 30 day period that has to happen if it's determined that they do need treatment I'm not sure about this I think the 30 days is really inpatient and we're talking about The inpatient evaluation once they're in the hospital the forensic evaluation has to happen So I have a question if there is if the screener determines the person's in need of treatment And it needs to be evaluated at the destiny of the hospital the doesn't name hospital to is the state hospital state hospital The Disney hospitals are a university of wrong medical center, but the regional medical center Wyndham center springfield probably retreat must like So what if there isn't a bed available where they go Generally the the practice is and it has been for Several years because of that availability is that The initial placement for a person when the judge has ordered inpatient evaluation is that that they would go If there is bail set, they would go to corrections or there would be Let annie or might just just discuss the delay in the person's process And if there's no bail Then that person would go to emergency room where they would have a psychiatrist see them to make that determination of hospital level here So this was part of the x 78 analysis resulted in The direction that you provided us to develop an mou between our partners here and then also to develop procedures to address This group of people who are unofficially known as the delayed placement persons dpp's And also to streamline and actually codify operationalize title 13 and title 18 requirements between all of us the people seeking hospital level of care Voluntarily or involuntarily and this is also the piece of legislation in which you directed us to develop mental Healthy units inside of the department of corrections that even though in the language of the law was forensic mental health units We came together to collectively understand that that was not the formal sense of the word of forensic mental health Unit like it might be in Massachusetts or Connecticut because that's an external forensic secure hospital And you appropriated six hundred thousand dollars Which clearly is not going to do that and that instead resulted in a department of corrections having an internal Higher level of care all the way to where somebody might be in hospital And that was enacted on July 1 of this year So we now have mental health units into the facilities and we included some information on that mo you at the request I really want to thank the four of you Helping to clear this all Clear it's not It's Again, I think that we recognize that there's different terminology Yes There's forensic and then there's forensic Some of the questions For the standing committee should we should we look at Something like should we look at Um Should we look at our real Those are some of the questions I think we have to ask Skills that last year you had a 12th bed facility forensic unit plan for The house Yeah I don't want to lose a point that sarah george raised which was also around folks who have traumatic brain injuries It was in the life school disabilities Yeah, that's a different department that we ought to bring you to the conversation Corrections is being asked to be all And anytime you asked it department But anytime you ask a department that's based upon Corrections models model to deal with offenders To be all things to all people you get the results that we're getting And I just know that I think our corrections department Does an exceptional job trying to deal With all of these problems, but they're being asked to be the institutional access work When there's nothing left for those with Developmental disabilities those with significant mental illness And the communities got up to here with certain individuals and they don't know what to do with them And that's when corrections is asked to step in In the midst of a serious opiate crisis Substance abuse and all that so With no reflection on departmental health, but I just think commissioner, you know, you've done a tough job of staying government in my opinion You're being asked to be all such odd people Well, thank you Thank you It serves me so I think you're right Yeah, I've been in this department for 29 years and in the population The acuity that the challenges of this population have changed so in market What's encouraging though is their staff have changed during along with that to the to the extent that they can Yeah Part of my vacation was more kind of evaluating and looking at other systems and how successful they've been And the european model in the norway system are really focused on Less about what I think both they call Static security which is breaking more of cameras the way that facilities laid out in procedures I know where you are and you're doing what you're supposed to be doing About dynamic security, which is all of the static factors, but it's really about human being And it's an interesting model to to evaluate In many ways from what has already moved towards that as far as the interaction But they've taken a lot of you know a significant step further where you know, they're essentially social workers And I think just one last point I think attorney general and general donovan made a really good point that we are focused on Smaller part of the population with a very high acuity But when I look across the system of care the mental health needs of reminders And we think about more beds, which is one answer and part of the solution But if we really want to get to what's underneath us, we have to look at the continued care And then really looking at our community mental health system And how do we support people from a more promotion and prevention aspect? Which is where we are seeing, you know enormous needs in our communities So we want to ensure that we have the right capacity To treat and support the highest acuity We also want to ensure that we're also focusing on the community mental health and serving people in the community to the best of our ability Thank you very much Thank you very much for the questions and for the day, Jack Tullock He deals with this Probably keeping him in his mind That's okay, this is very important too Good afternoon, I'm Jack Tullock I'm an attorney at the Law League of Law And I was working on a mental health law project Which I've been doing for about 25 years Of course I love what I wrote up to say But hopefully it answers his questions The mental health law project represents people in All the people in voluntary mental cases In the health cases all across the state Inpatient commitments, outpatient commitments In voluntary medication cases The one set of cases that we do not do Are the hospitalization hearings In the criminal division of the superior court And we'll talk about that in a little bit later But all the people that we're talking about today Are people that we are either representing Or we are likely to represent The people who are the subject of Criminal charges And are you either found by the court To be incompetent to stand trial Or found by the court to be insane In the time of the alleged offense If they then go from there To the involuntary mental health system We don't handle the initial hospitalization hearing But any subsequent hearings such as Application for involuntary medication Because the person is not taking prescribed medication Or a request to extend the order of hospitalization Not hospitalization before the initial 90 days We are planning to represent people in all of those cases Possibly the most important thing I can say At the outset is that a criminal defendant Who has been found incompetent to stand trial Or a criminal defendant who has been found Insane at the time of the alleged offense Is an innocent person It's a person who is Entitled by the constitution To the presumption of innocence And they're entitled to be Considered by our law, by our system By all our institutions To be an innocent person They've not been convicted of a crime Nothing that the courts do Or the government does to these people Or with these people Can be based on a desire to punish them For what they have done or alleged to have done Or to deter them from future criminal conduct I know that when we get very widely publicized cases Typically a dramatic and violent crime There tends to be a public upcry Or outcry about these things And there's a natural desire to say Well, we have to do something to this person Because to look at this terrible thing they have done And I think that's clearly going about Looking at this in the wrong direction Even when we think about the proposal The question of how long the person is going to be in State custody Proportionality of the detention and the alleged offense Is not an issue in the involuntary mental health system The involuntary mental health system Really addresses two questions What are the treatment needs of the patient And equally what is necessary to keep the person And public safe As you've heard, if the criminal charge is dismissed The initial order of hospitalization Can be for a period of 90 days Can be either an order of hospitalization Or an order of non-hospitalization And most of the cases We've got a lot of people in these situations Where they've been charged with a crime And they wind up in our case load But most of the cases you all never hear about Because the charge is disorderly conduct Because they're in nuisance on Church Street Or unlawful trespass Because they wandered into someone's house And they didn't belong there Most of those things the public hasn't heard about Because the person does not pose a severe long-term Danger to public safety In these cases The person, before the end of the 90 day period The Department of Mental Health Can file an application for continued treatment And in the Family Division of the Superior Court We are appointed to represent the person And the court evaluates the question of whether The person is a patient in need of further treatment And I don't know if that was part of one of the handouts It probably was But the two problems of the person The patient in need of further treatment are One, someone who's personally in need of treatment Which means they're mentally ill And both are present danger to themselves or others Right now Or someone who's receiving adequate treatment So they're not dangerous right away But if treatment were discontinued in the near future Or if treatment were discontinued They would become in danger to themselves Or others in the near future So the treatment team at the hospital The Department of Mental Health And of course the court Is always looking at not just what treatment Does a person need But what treatment does a person need And in what setting In order to prevent that person From being in danger to the public And those cases There's no time limit to those cases The person in a case such as this Is potentially subject to detention And custody by the state of Vermont For much longer than any possible criminal sentence They would have had If they'd been tried and convicted of the crime They could go on forever And we have I can tell you the courts And the Department of Mental Health Take the public safety question Very very seriously I represent people who've been committed Based on events 10, 20, even 30 years ago And they continue to be held In the custody of the Department of Mental Health Possibly inpatient Possibly outpatient Under very strict conditions Even though they want to be released We have clients who come every year When their case comes up They really want to give up their order And they ask me, well How much is enough? When do I, when do I Done my time or go to my death in society And the answer I have to give them is The time is not a factor As long as the state believes And can prove to the judge That we are a potential major We're going to be doing this every year We're representing them And doing what we can to To achieve their freedom But many of those people It doesn't matter They'll be held as long as they're Determined to have mental illness And attention for a danger To you and yourselves or others So when the suggestion was made That the determination of whether to extend In order of non-hospitalization Is based solely on the interests of the patient That is absolutely not true Another thing that is worth pointing out Because these cases come back Year after year in court It's not true that these cases Are always confidential The Supreme Court decided a case years ago Called state versus court And the question was The newspapers wanted to get into A mental health hearing to see What's going on because it was A very dramatic and violent event And the trial court said no And the Supreme Court said That there's a public interest In knowing that the department of mental health Is adequately protecting public safety And they're doing things right And so probably all of you on this committee Have actually seen news stories on TV Where you've seen me in court Probably the back of my head somewhere Where one of my clients has been In an application for continued treatment hearing And the news reporters on the TV I kind of have been there because It was determined that the public interest Militated in favor of allowing that publicity I think one of the interests From the victim's point of view Would be to know when somebody's being released From a DMH or whatever category Of order that there is And that doesn't seem to be available I agree with that I think that I agree with Commissioner Squirtle That the law does not allow for that And whatever actions we'll take In the long list, we should start to see How the federal law would allow that To be done But if we could adopt the Connecticut model, I would assume That that's passed a better law I'm not familiar with that I'll look at it I'll just turn it back on today A couple of questions I kept running a list of questions I was listening this morning The first question was Who does the forensic evaluations? It's the state contracts With a list of psychiatrists Who have private practice Around the state Who do these forensic evaluations There are four of them None of them are solid in my bill Which is a problem If we had to We would love to have people In the southern part of the state Because that way we wouldn't In my case too We would have to pay a psychiatrist To try from Burlington or Waterbury All the way down to Rutland or Stratover and the CNR We can bet it We can bet it We do send people down to that And it's a whole day Did you say psychiatrists or psychologists? Psychiatrists We have a hard time Having 40 hours a week And we can find psychiatrists In Benedictine County Let alone for evaluation Another question was Who are the screeners in Every county is sort of By one of the designated agencies And community metadol centers The screeners Who are called out to the The same people That are referred to as crisis clinicians Who are involved in Doing the emergency civil evaluations To decide if the person needs Hospitalization criteria And how do we get to this point Where someone is making this determination Before the person gets sent to the hospital Because the legislature decided years ago That there are too many people Being sent to psychiatric hospitals Or forensic evaluations Who really didn't need to be in hospital And so rightly The legislature said We're going to have some evaluation done Before the person is ordered To be hospitalized I think that was the right decision Because it's a big deal For a person to be hospitalized And it's expensive for the state To pay for them to be hospitalized So that's why we are All over the world now I think I'll stop there And see if you have any questions About the prevention disorder Of thought, mood, perception, orientation Or memory And so there could be some things That you and I might say, well Some really has a mental problem But they may not be Unmental illness Pursuant to the monstarchy PTSD Can be a tricky one The same thing With either borderline personality Or we just don't have any social personality Traumatic brain injury Traumatic brain injury You can actually have a Substantial disorder of thought Or memory as a result of Traumatic brain injury Or perception And so even though It comes from TBI You still might be diagnosed In seven or eight months Well, I don't know Where to Where to end But I know where to begin