 Okay. We, we took a break. We're now back on YouTube, uh, streaming. Uh, it's Wednesday, April 14th. This is the house health care committee. Uh, we had just completed hearing from a witness, uh, Dr. Uh, Robin, uh, and we had interrupted our testimony with deputy commissioner morning Fox. And I'd like to return to that. I think we were at the point of, um, I think we had gone through sections one through four. Am I correct? Yes. Yes. So let's, let's, um, yeah, so let's, let's turn to section five and six and, um, again, can we turn it over to you to share comments? Deputy commissioner. Sure. Um, I, I, I don't think I'll kind of read through the, the sections. No, you need to, I think just make comments as you wish. Yep. Um, you know, as far as section five, the assessment of mental health services within corrections. You know, we're in support of that, that, uh, that section in the work to be done there. Uh, as commissioner Baker and myself have testified, uh, in other committees. Uh, we do request some additional time, uh, for, for that, uh, study in order for it to be as robust as possible. And, uh, you know, if, uh, the legislative session, uh, were to end in, uh, you know, May, let's say, we're really looking at about four or five months. Uh, timeframe, uh, to get that done. Uh, which is possible, but it's just, it's a little tight. Uh, in, in doing that. But I think it's an important, uh, piece to make sure that we're really looking at what are the actual types of services, not only available within corrections, but also in the community. Uh, the timelines and, uh, for access to those, uh, services, uh, and how, how those compare. Uh, also knowing that, uh, uh, department of corrections has a new healthcare provider in the past year. Uh, and the impact that, uh, having a new healthcare provider has had on any of the services being provided within corrections. So you have a suggestion in terms of extending that time. Uh, what commissioner Baker had asked in, uh, house corrections and institutions, uh, was for, uh, a year from this date, basically. Uh, so looking at sometime mid-session, uh, next year, uh, uh, thus allowing still getting that report into the legislature, but still having some time to be able to address those findings. Okay. Can I ask a question on this? Because this inventory, uh, touches on a number of issues. What is the relationship of the department of mental health with the provision of mental health services in the department of corrections? I would say it's a committed relationship. I think, you know, all joking aside, uh, we have a very strong relationship, uh, with department of corrections. We have very frequent, uh, conversations, you know, uh, case by case or department of corrections will. Oh, go ahead. I just realized that I want to reframe my question slightly actually. So finish your, finish your comment and then I, then I want to, yeah. So, so basically, you know, we have, we have a lot of conversation case by case conversations where they see consultation for individuals that are within the department of corrections custody. We also will work with them should an a incarcerated individual, whether they be a detainee or someone serving a sentence. Should they there be a question as to do they need hospitalization will not only consult with that, but also then help facilitate those admissions as needed. We also train the staff, the clinical staff who work with the contractor to be qualified mental health professionals so that they have the ability in house to be able to begin the process for emergency exams. Should that be needed in the past. They had not been. And about two years ago we began that process. And partly because of helping to increase the the timeframe and access to hospitals or hospitalization for individuals who may require involuntary hospitalization. In the past, what would be required is that if department of corrections felt that they had a incarcerated individual who met that criteria, they would have to contact a local designated agency, who would then have to coordinate coming into the facility to do an assessment. And that's all valuable time that that one is waiting for that assessment to determine if they need that level of care. So that's another piece that that we have done. That's, you know, the, the major tenants of it but our care management team regularly consults with both the healthcare provider, as well as doc staff in regards to, you know, cases and case by case situations. Okay. And so, but the further question that has zeroes talking occurred to me is that what is, so there's a memorandum of understanding between the Department of Mental Health and the Department of Corrections. And that's a public document I assume. Could you share that with us just so that at some point, you know, some, some interest in seeing that. So my question, does the memorandum of understanding address your relationship. Do you have any oversight relationship of the contractor who provides health services to the Department of Corrections that's that's really in part my question. Yeah, no, we do not because all of, because isn't it fair to us isn't accurate that the health and mental health services other than stepping out into involuntary commitment or evaluations for that. Are provided on a contractual basis with a vendor. Am I, that is my understanding or is that your interest is that your, is that accurate. Yes, all those services both health and mental health services are provided by a contracted vendor. When the Department of Corrections put out their RFP and eventually contracted with a new vendor. The Department of Mental Health was a part of the review committee and interview committee for that RFP response and and in the decision making around the contractor. In fact, you know, that was part of my role was doing that work with with my partners at DOC to give our input from the mental health lens to the contractors ability, history, services, etc. Of what they could be providing to incarcerated individuals. We have no direct oversight, no direct oversight from the Vermont Department of Mental Health to that contractor in the way that there is for the community system. Where you have a direct oversight responsibilities for quality of care and provision of services and throughout all counties of Vermont. Right. And I think they have part of that is through through our master agreements with the designate agencies that were able to ensure that that type of oversight whereas we're not a part of that agreement with the correctional health care provider. Has that been ever been contemplated that the Department of Mental Health would have a direct responsibility and role with the provision of those mental health and health services will in this case mental health services to those Vermonters, who at that point in time are in the correctional system. In my tenure it hasn't really been contemplated as something that we were looking to take on. And I think, you know, it's an interesting question. I think at the Department of Mental Health. We're concerned about mental health treatment for all Vermonters, as, as you're mentioning. And so we want to be involved and that's why we requested to be a part of the RFP process. And why we fully supported working with DOC and creating the memorandum of understanding. I guess it would, it would be, it would be something that I think we would have to explore to see what that would look like what and, and the legalities and all those types of pieces of how we could have more oversight if it were to be decided to do that. Right. You know, I just it occurs to me that I might want to include something to do an evaluation of that as part of this work groups work or something that effect. I mean, it does. Anyway, it occurs to me as we're talking about. And we wouldn't be opposed. There may be other ideas that come forward. I don't know. Sure. And, and, you know, at least sitting here in this moment. We wouldn't be opposed to that being a part of the study to take a look at, as I said, Department of Mental Health is and should be concerned, you know, with mental health treatment for all Vermonters. That is our charge, at least how I see it. Right. Yeah. Yeah. Yeah. Yes. Thank you. This section five. Yeah. Yes. Deputy commissioner. So understanding this then. And, and, uh, Repp Lippert I'm glad you brought that up that that's an important thing about the contractor. So the contractor is dealing with those, those folks in the mental health unit that, that are in corrections and, and you folks are dealing with folks that aren't in correction, but are in the mental health institution. Is that correct? Is that how that so you could literally be, you know, have somebody come from somewhere. What was contract? I'm not. I don't mean to denigrate them. I mean, they're a contractor who qualified to do the work, but they're in the same building hospital. If you will facility that you are, you are providing civilians. They're providing people that are incarcerated or ready to stand trial. Is that is that how that works. I'm not sure I'm understanding the question. The contractor for the Department of Corrections provides mental health services for all individuals within Department of Corrections. Period. Whether they're in a mental health unit or, or not. And DMH has oversight of mental health services in the communities and with our designated hospital. Okay, so I'm misunderstanding. I'm misunderstanding. So the contractor is providing mental health services for the employees of the Department of Corrections. The incarcerated inmates. Incarcerated inmates. Right. So can I just step in because I think maybe you're talking across. I think I am. Okay, but I think so I think maybe the question that I hear representative Peterson asking is, are there persons who come from the criminal justice system into a, like, into the, the facility in Berlin, or other facilities who are, are they, are they ever under the Department of Corrections responsibility when they're also in a facility run and licensed by the Department of Mental Health and what, where does the contractors responsibility fall in all that. I don't know if that's part of the question represent Peterson. I guess I just, it didn't occur to me that our state employee people, mental health experts, psychiatrists are working side by side in some instances, I think, or maybe not actually I don't think they are. Okay, then I'm way off. Okay. But, but if someone is in a correctional facility, and they are receiving mental health services as an inmate in one of the correctional facilities that is provided by the contractor for the Department of Corrections. Got sure. But that's why I was asking, but I was asking, are those provision of those services and is that contractor under oversight by the Department of Mental Health and what I'm hearing is that no they're not. The contractor operates independently of the Department of Mental Health. And I at least wanted to raise the question about, should there be some role for the Department of Mental Health in an ongoing way not just for selecting the contractor, but for ensuring that the services are appropriate. They're consistent with what the state's criteria are. And one other piece of that is that, again, most, I think, based on all the testimony we've heard for years, most of the services provided in Vermont for mental health services are provided by nonprofit providers. My understanding is that if I believe I don't know it can't speak to the current but many of the contractors who have been contracted with our for profit providers. Now if I'm wrong on that I'd like to be corrected about that as well. Do you know if the current provider of health care, including mental health care to the Department of Corrections is a for profit provider or a nonprofit provider. I don't believe that they're a nonprofit entity. I don't think they're a nonprofit, so I eat profit. Right. So I, again, for me it raises a question of whether the standard of care is the same when you're contracting with a for profit health care provider, as opposed to a nonprofit health care provider. I personally would like that to be part of the questions that are asked as we look at the relationships here. And there may not, I'm not drawing a conclusion, but I think it needs to be asked. Because we're also, we're facing those issues, frankly, in the Department of Corrections in terms of use of for profit correctional facilities outstate as well and there are implications. There can be implications. And it would be my hope that that the study, which is looking to compare really what the services types, availability, access, etc, within Department of Corrections, and how that compares to what's in the community. And as you mentioned, Chair Lippert, what's in the community. A large portion of that is by nonprofit agencies. And so having that comparison will be enlightening, I think. I think so. I think, yeah. Representative Page, I think, and then Representative Donahue. Yes, Chair, and I think you raised this as well. The services that are provided mental health services in our correctional department. Are they the same elsewhere outside of the state and I think you briefly touched upon. Yeah, that adds a whole other layer of question. I think that's, yeah, I think that I don't think that's articulated here, but I think that's a very important question that should be. Yes. Was the question just, sorry, Representative Page, it was just a little quiet on my end. Was the question, are the services within Department of Corrections the same as outside of the Department of Corrections within Vermont? No, it was, are the services that are provided mental health services to our individuals incarcerated in Vermont. Are those services the same or equal or even better outside of the state for those that are incarcerated outside? Not compared to other corrections. Yeah. Yeah, that's a really good question. Yeah. And again, Woody, I just made a note, I'd like to think about incorporating that into the into the evaluation there. Thank you. Representative Donahue. Yeah, thank you. The one concern I've had about the language and I'd love your insights on it, Deputy Commissioner. The implication seems to be we want to compare these because what's in corrections ought to meet the standard of what we offer in the community. And if it if that's the approach that this would be what we want to see as a standard of care. We know, for example, that at times there are long waiting lists in the community to access mental health care. So is your understanding that the assumption built into this is that we are looking to the community as we ought to be doing as well in corrections, and that what's in the community therefore is an appropriate standard. Because that my concern is one where we know there are gaps in the community, not sure if we want to then say that's the ideal system that's the right standard of care and therefore we should equal it and if you only have to wait four months in the community then waiting four months and corrections is good also. Right. I think your, your assessment representative down to you is is pretty accurate. As far as how I read that section, it really is looking at a comparison of what happens within the walls, if you will, Department of Corrections versus what happens in the community. And one could make the assumption then that what what is available or current practice or current norms in the community is best practice. And, you know, I agree with you that I don't think the end. I don't think the end. I don't think the intent of the for us in doing a review intent is not say well since you might have to wait four months to see a psychiatrist in in the community. We're good because it only takes two months, you know, within corrections or something of that sort. I think there will be parts that will show that there there may be, you know, quicker access within corrections than there is in the community. And I think that will be enlightening. But I think, you know, if we want to really look at it. And I think we should look at what are our best practices and norms and what are, you know, recommendations from organizations like SAMHSA and, and others as far as timeliness to services and not just what the current state of affairs are out in the community. I'm thinking on all these perhaps we can come up some language that articulates some of the incorporate some of these these questions further. Other questions or other any other comments from deputy from Fox on this. So let's turn to section six. So my testimony prior and again today on this section is that we have tremendous support for the need for this forensic care working group. There's a lot of issues that need to be discussed and we need to be sussed out for what Vermont needs what our gaps are. How we can mitigate those and, and really create a, a, an impactful movement in our system of care in general. The looking at gaps competency restoration models, etc. I think are incredibly important pieces, as Dr. Ravin mentioned, you know, having a formal competency restoration program in other states has shown that anywhere between 60 to 80% of individuals who have been found not competent to stand trial can be restored to competency. And for me, I see this as a civil rights issue, and not just a criminal justice issue in that we have a person who is being told they're incompetent stand trial for an alleged offense. And they're not convicted of it they haven't been proven that they've done it. And I really truly believe they have a right to face their accuser. They have a right to formulate a defense. And I really see it as a civil rights issue for individuals to be able to be found competent to be able to put on their own defense, whether it's a sanity defense or not. And, and to move forward and have, have that case, formally adjudicated. I think that also is something that's extremely important for victims of offenses to have it. There's always going to be that question of, is this the, you know, those type there are some circumstances where I think it's clear, people really kind of know, you know, gosh, there's no witnesses, you know those types of things of an event. However, it's not always that clear. And I really think that it's a civil rights issue that individuals have the right to be able to formulate that defense. And so having a formal competency restoration program, both in, in the community as well as within our hospitals is an important step for us to move forward on. And I think that, you know, Representative Peterson had brought up the question about people trying to game the system and such like that during during assessments and, and I think that's part of competency restoration programs but also just looking at our system in general, and looking at folks, I agree with Dr. Ravin that it's not the most common of occurrences, but it does happen. You know, there's specific types of psychological testing that can help kind of delineate and show whether or not someone is is trying to, as as resident Peterson said, game the system. You know, but, you know, so I think there's a lot of a lot of pieces here that that we are important for us to look at. I've heard some testimony from others during this that having language in the, in the work group the mentions things like looking at psychiatric security review boards or the Connecticut psychiatric review board could be too prescriptive or leading folks in a department has no problem with that language being taken out taken out of the bill, I think we need to look at all types of systems and I personally would not want anyone to think that it was biased one way or the other going into it. I think this is a really important work, and it needs to be crafted in such a fashion that we're really trying to mitigate anyone's concerns that something might be too prescriptive, or trying to lead something in one direction or another. Similarly, with the language of the need for forensic treatment facility. You know that language. I've heard some folks bring up that that kind of implies that we need it. And I think that it's important for us, you know, similar to my language that I suggested for the own age part in the study committee, if we need such a facility. So those types of language changes, we definitely support not looking to make this prescriptive. I know, and the, and the department knows a lot of the different areas that we want to study and to look at. But I think Dr. Ravin makes a great point about being able to contract with and bring in regional or national experts that can help us really take a look at this, and not just rely on, you know, maybe my own personal expertise in this, in this field, or, you know, Dr. Ravin's, but others as well, who are outside of this. And, you know, and so I think those pieces are very important for us to really consider as we as we go forward with this. Can I just interrupt you on that point because it was a question I did want to just very directly asked because I actually in reading the language shared some of the same concerns that there's that there. One could read that there's already conclusion that there should be such a facility and then the question is what kind of building should it be in and how many beds there should be in. And I, I, frankly, I'm unclear whether there has been a conclusion drawn that there should be such a separate facility and whether the Department of Mental Health has drawn such a conclusion at this point in time. I think our opinion is that, that there, there likely is that need, but I personally, and as a representative department are open to having this discussion to really just have other people's input as well as like I said, having other experts weigh in on this and take a look at our system of care here and how we can do this best for Vermonters. From my experience of the, the trials and tribulations of trying to manage criminally justice involved individuals who have significant public safety concerns being placed in psychiatric hospitals as incompetent to stand trial without the ability to really have them restored to competency. Our goal is really to treat the individual. And so my concern comes out of a place of we have an individual who's been hospitalized who is needed to be hospitalized. They're incompetent to stand trial. We treat them that is what we do in the Department of Mental Health is treat people's illnesses. And now they no longer need to be in the hospital. And now what? That's, that's the issue for me. Our psychiatrist at the hospitals cannot call the court and say we think they're now competent. So get a new evaluation. The court will say that's nice. And really, you know, it's up to, you know, defense and state and other folks to make that decision. We don't have that capacity to kind of say, this person's now competent. And, you know, that the doctor is saying they're treated, they're now competent. This needs to be, you know, reassessed and, and further discussion needs to be decided as to where this person should go. If we, since we can't do that, we treat them. We cannot keep them at a hospital for just public safety reasons. That's what puts our federal funding at risk that they made this that CMS the Centers for Medicare and Medicaid Services. That is the majority of the funding for the Vermont psychiatric care hospital can come back in and say, we're not going to pay for the time that that individual was there, or even decide to say that we're not going to pay for that facility because you're keeping people there for public safety reasons, not for treatment reasons. And so those are some of the complexities that really deserve a thorough investigation, a thorough study with some recommendations for improvements or changes as necessary. And I guess I want to just say that I, I want to share your earlier comment that there not be a perception that this this study has already has already drawn its conclusions before it's taken place. So I think, and I'm just, again, speaking for myself having having been part of dealing with some of these directly and indirectly for years in the legislature. I think it is time for us to have a thorough understanding of these issues and with some recommendations, but I'm concerned that we not prejudge the outcome. And then therefore once again feel like the evaluation, the study or the evaluation didn't serve its purpose. Right. And I also think that's why to on this section. Similar to Dr. Raven. I really think we need more time than November 1 to do this. This, this, the study to include looking at competency restoration programs, assessing all the gaps in our system. Should we or should we not have a facility and then if that's a yes, all the other pieces underneath that of how it should run who should run it. How many beds all those kind of questions on top of looking at the own age notification piece and if that should be included in a bill. And if so, how these are a lot of pieces. And, you know, if the committee wants a report just for a report sake, then November 1 will be fine. August 1, August 1. It's actually an August 1 date for this report. Well, it's not I apologize. I apologize. I apologize. No, no, I'm confusing dates. Yes, you're right. But still an August 1 to November 1 that gives us, you know, three months to try and do something that really is is is a large lift. But like I said before, I am passionate about how important this is. There are civil rights issues that we're talking about here for for individuals and and a potential impact to our entire system both mental health and correctional. And so if we're going to do this, we need the time and some of the resources to bring in other experts to really have a thorough evaluation of these needs and the gaps. So that we can come back with a healthy and robust report and with recommendations that are clear for this and other committees to consider. And if I may, Dr. Robin. Also mentioned resources. I don't believe that any resources set aside specifically for this at this time. Is that right. Not that I'm aware of at this time now. And in the department of mental health is being asked to convene this group. And I assume that means to staff this group. Correct. So, I would love to have some funding to help resource this. Not only our staff time, but also like, like myself and Dr. Robin have both testified to the importance of bringing in either regional or national experts to really enhance and enrich this, this conversation. I can't think of a more important conversation that that we're having right now than, you know, there are so many civil rights issues that we're, we're, we're dealing with today and this is one of them that seems to sometimes fall to the bottom of the ladder. As far as public awareness goes, and I think it's really important that we do this justice. I don't put you on the spot for it's right now, but I would ask if you would bring back to us some thoughts on a recommendation for resources that you believe would be sufficient to appropriately allow this to provide the thorough evaluation that you're referencing. So I can get that recommendation to you probably around the same time I can get you the copy of the MOU as well, the Memorandum of Understanding. Fairly short turnaround. Yeah. So we have some other questions I'm aware of our time but I think we're doing pretty good I think I'd like to keep moving but that's here the questions and then I think we cut you off I cut you off by asking your question earlier but but I think it's frankly is valuable to hear your responses to that. So represent Peterson represent down here. I have to let go first. Yeah, good. I have to step out in a few minutes so if I can just jump in and also were you referencing the MOU with corrections. In getting that. That's what I asked about yes we that's posted yeah we had asked for that we received it we didn't receive the attachments that it references but we do still need those. So, I mean I was waiting to ask my question a lot of it was sort of late on the table. I strongly agree with how important this is I've been actually trying to bring bills to have this happen for a number of years now with really digging into these issues. My concern that I want to articulate for the Deputy Commissioners response. We actually had a similar, similarly constructed study group in 2018 that focus solely on the issue of on h's orders of non hospitalizations and actually had a smaller number of stakeholders and had more time to complete its work. The subject was really massive. There was easy consensus. And the end result of the scope of the task, etc, was that that the report was not useful, I think, and did not ever see any action in the legislature and I actually asked to have it posted in case people want to take a look at what the outcome of setting up something like that. So, I look at this and it's similar question to what I asked Dr Raven earlier. There are at least six different very substantial issues. I would suggest that any one of those six. The other work group could spend a year, really understanding the issues and actually bringing forth as is requested by its proposed language for statutory revisions. And there's a really big number of people who all have, you know, different interests and different parts of it and some some strong opinions on different parts and it's. There's a lot of people around the table which always makes conversations take longer. And a lot of them there have specific interests but not necessarily expertise. There are a lot of different models around the country. I think the work in terms of expertise and identifying different models itself is a separate piece of work that really would need to take place before. A place before a group started hearing so my question is, do you think that it's remotely feasible or productive, not that I want to stack the question that it's remotely feasible or productive to have this many complicated, critically important topics, all as part of the scope of a work group of this size weighing in in terms of actually coming out with a useful set of recommendations and language for the legislature to look like look at next year. I would say I share your concerns. You know, it's a can when you start getting a group this large with as you say, very interest but not necessarily expertise. It's akin to herding cats. And we're already on a short timeframe. I agree that any one of these topics could be a six month or more study to do it any kind of justice. I'm open to conversation about how to structure that, whether it's staggered in and how each section is looked at. I think it also would make sense to look at the, the listed members as a part of this, and in which part of these should they actually be represented that. You know, I think, like the discussion of, should we even have a forensic facility. In my counterparts at BGS, that's not an area that they need to be involved in. You know, things like that you know we need to, to really kind of look at who the members are, and in, in which area they're, they're participating. And whether that's done more organically, if you will, after it's set and we decide okay we have a year to do this. And if DMH is kind of facilitating this that we're able to say, these are the folks that should be in this conversation these are the folks that should be in that conversation, something like that, or whether it's more prescriptive in in the legislature in the legislation. And so I think that's, that's what we need to look at. And I think there's areas here that we're still, you know, you know, I can add to this. No, this isn't a complex issue. These are complex issues. You know, each and every one of them. And, you know, so, so I think that's, that's what we need to look at. And I think there's areas here that we're still, you know, you know, I can add to this. You know, we're, you know, the adjudication of not not guilty by reason of standing or incompetence and trial. The language is, you know, due to a mental disease or defect, and that's not always mental health. And, you know, there's really no conversation here about how this impacts Dale and their system of care and their involvement. So I think, you know, we need to, there are those pieces as well that that concern me in trying to get this work done. But I can, I can give you my assurance that my own personal assurance that this is something that I'm passionate about and want to make happen. And what, and I want and feel that this is something that needs to be useful. And it will be a report of this nature that will come back to the to this committee and others that will be anything but prescriptive and recommendations and, and strong voice of, of what Vermont needs will be less than helpful, and it will be a waste of a lot of people's time, energy and money. To be honest. But I don't have a quick answer as to how to, to fix that. Well, I think you've made it. If I may, you've made a number of comments, which I think, you know, at some point, this committee is going to have for the committee discussion and I've been making some notes here of things that we might integrate or change or modify some language and I think they're, you know, frankly, it is our task we're being asked to help identify and then make recommendations for how this, this might be modified. So it does follow us to come up with some type of proposal. And I, you know, I think that's going to be a next step, once we have also opportunity for some more committee discussion as well but I think we've been our take, I think we've been a little soliciting suggestions throughout as we've, as you've testified in this questions have been asked of yourself and Dr Robin and perhaps others. But we do also have a timeframe in which to get a proposal, which for us is the very latest by the end of the week. So we have, we have things in front of us represent step out I will be back, hopefully, quickly. Yeah. Okay, thank you. Further comments. I'm trying to think where we were. Well, I think I think part of the you've spoken to in part the issue of actually having the ability to actually evaluate whether a forensic facility is is the appropriate thing and then, and then you maybe have indirectly talked about I mean talked about the bill. I mean, if it is then that's when it would be appropriate to look at some of the other issues, rather than to step into it immediately. I take that as similar to the earlier part in the bill where if a defendant is found competent, then assess for sanity. And if they decide that there's a need for a facility, then let's talk about what it looks like who runs it how you know, all that type of stuff. And or fiscal impacts. Yes. Because there will be. Right. Other comments, because I think we've, I think you've touched on really most parts of sections five and six at this point are there other comments that you'd like to make just generally at this point and. In the amount of time you've taken with us and the fielding questions from folks. No, I appreciate the time I will do this all day long and all week long. I testified on this one not asked to testify and this in other times. And I might just mentioned that we may be returning to this this afternoon after the floor. So to the degree you might take a look at your schedule this afternoon it might actually be useful to have you available to be a resource. See what I can do. I know that representative black had asked a question about, you know, this kind of being more of a response to some things. And I think that's why I also brought up, you know, I think we need to really be be careful about how we look at stuff. So, so first of all, you know, I don't see it as a response I think it does respond. I don't see it as a response, particularly because some of this bill, you know, really, you know, started well over a year ago or two years ago. But the reality is that I think we need to make sure when we're talking about this that it becomes easy and common vernacular these days to to reference issues that an individual may be having as mental health. So that's why I recommend, you know, that that Dale, you know, an adjudication is mental disease or defect that could be traumatic brain injury that could be intellectual or developmental disability and things of that sort. And, you know, I think, common day modern vernacular media, etc. is when someone has issues where they may behave different than quote unquote, the norm, it's mental health. And I just want to caution people that what may be termed mental health isn't always mental health as we define it. And that that's an important piece for us to kind of suss out in some of this study. That's why I think it's important to have some representation from other areas like Dale involved in this. So let's get into the, the whole, how do we not only sequentially intercept or, or, or try to work with people to mitigate risk factors for violence in the mental health world, but in any world, and such. So, I'm aware of our time but I'd like to ask one other question. We really didn't talk about the membership of the study group for sale and that it's large and it is convened by the Department of Mental Health so I'm assuming that the Department of Health participants is not just convening but participating. Yeah, but do you have any other thoughts in terms of the membership. I mean, I hear you saying perhaps so many perhaps let's assume for a minute that that there was some way to say these this this part of the group should address these issues this part, those issues, etc. And there's an overlap I'm sure for numbers of people. But, but what I'm hearing is that there's at least some part of this where Dale representation from Dale would be in order. Yes. I think that some representation from Dale. You know, in here it mentions the director of healthcare reform. I guess I would add or designee, you know that's an individual. Right. You know I think that that could be cum burdensome for for one individual depending on on on that. I think that might be true throughout that's I mean I think we would rewrite the statutory language which often says the, you know, the office of the defender, the defender general or designee or etc. So I think or designee will probably be incorporated throughout so that. But but other other official groups or stakeholder groups that you're thinking of at this point that we should be at least thinking about in crafting a revision. You know, I think that, you know, in one sense, you know, trying to keep in mind the larger of a group the more difficult it gets to accomplish things. And so, you know, I know that it mentions, you know, two crime victim representatives, but mentions a single person with lived experience of mental illness. And, you know, I would personally think that maybe then it's to, you know, at least, you know, something like that, a person with lived experience with mental illness. You know, I guess the piece of the of the list that I, I like and hopefully will stay is that any other interested parties permitted by the commissioner of mental health. Then that gives us some latitude when someone says hey I think we're important for this. You forgot us or, you know, etc. We can say, Oh, okay, you know, great. Because I know like the Vermont Medical Society had asked about that and I think in particular because of Dr. Ravens expertise and frankly was thinking about that as we were looking at this I didn't know whether. Yeah. And I know that they were they were seeking to be on that but I, I never really put forward myself saying suggesting that they need to be on there, because I was aware of Dr. Dr. Ravens expertise and desire. And I'm like, well, the commissioner of mental health can allow anyone else permitted so hopefully I don't get fired or you know something like that in the meantime and I will follow through on my commitment to them but you know that that type of thing. Okay. But no I think I think the members are appropriate. Part of what needs to happen is who's at which table, if you will. And when, you know, right. Okay. Other question committee members questions. In the next few minutes for Deputy Commissioner Fox. I'm not seeing any right now I. So I would ask and it sounds like you're you've offered to be available to us as we think about crafting incorporating some of the suggestions that have been made throughout the morning. And I think that you know we'll take that's that's going to be part of the charge that this committee needs to take on. So, we would welcome that from you. Yeah, just let me know when and if you'd like me to come back I believe my schedule is. Although some people might not be happy with it my schedule is flexible enough that I can I can make make time this afternoon. We'll let you determine who you make unhappy. No, just let me know when you'd like me back and I will plan to be here. Try and answer some other emails and other work other work that I might have to do. Just a few other things. So this has been, I think this has been an extremely helpful morning. And I should say that there have been some others who have been in touch saying you know we would request being able to be heard by your committee as well and we're going to try to figure that out. But, but I, but frankly I do think this has been very helpful. And as a lit elicited a lot of useful information and suggestions. And I want to thank each of the committee members who participated in this. I'm going to suggest, I'm going to suggest that we bring this to a close for the morning. We will, I, is my intention for us to return to this this afternoon as, as committee discussion and I don't know there'll be any drafting done between now and when we come back but I, I think there's a number of people who know it's in Katie's Katie's with us. I don't know she'll be able to be with us this afternoon. Katie, are you committed elsewhere this afternoon or I see Katie is here. I have here. I believe I'm supposed to be in another committee this afternoon, but I will double check with them to see if they're listening to witnesses are doing Mark. Is anybody considered cloning. I would be open to it for sure. It might be easier. I don't know. I don't know what the process involves so I don't want to volunteer anybody. Okay, well, let's let's check Katie, Katie, because I think it might be helpful to have you join us if it's if it's possible. So let's call this their close for the morning. And again my understanding is that the floor should be relatively short today. I could be proven wrong in an instant. But we're going to the floor at believe 115 and then let's plan to reconvene here. Like 15 minutes after the floor does that does that give people enough time to transition. With the goal of returning to these issues and having committee discussion and trying to begin, you know, formulating a proposal.