 So good afternoon. This is the House Health Care Committee again, and it's February 4th. It's two in the afternoon. Let me just put a frame around what we're going to be doing this afternoon. This morning we, today we're spending the entire day on understanding important aspects of the Vermont's mental health system of care. This morning we spent a great deal of time with the commissioner and deputy commissioner of mental, the department of mental health. We were scheduled to hear from Julie Tessler and one care, which are not one care, one care partners, which represents the designated agencies in the mental health system. And because of the time pressures of the morning, we, and Julie with Julie's agreement, we moved her testimony to tomorrow afternoon after the floor, no, after the, at 1, at 1.15, because we have no floor tomorrow afternoon. Floors in the morning. So again, for those who may have looked at our previous agenda, Julie Tessler's testimony will be tomorrow afternoon at 1.15. And so this afternoon, we are going to continue our understanding of some significant aspects of the mental health system of care in Vermont. And this afternoon we're pleased to have with us representatives from a number of community, partner organizations and stakeholders. I'm gonna run through the list of folks and then we're going to, we'll start first by hearing first from the Center for Health and Learning and it's director Joellen Torello. And they also do a lot of work with Vermont suicide prevention under contracts and grants. We also have with us, Dan, and I'm not sure, Dan, if I get your name right, Toll, but who is with a peer support staff member and a member of the state program standing committee. Then we have Lori Emerson, who's the executive director of NAMI Vermont, the National Alliance on Mental Illness. Kareem Chapman, executive director of Vermont Psychiatric Survivors and A.J. Rubin with disability rights, Vermont. So we're gonna start with hearing from the Center for Health and Learning and we're gonna ask each presenter to take maybe 10 minutes most in the outside to describe your programming and then leave some time for questions so that we get a chance to hear from everybody in the course of the time we have this afternoon. So welcome, Joellen. And I welcome you to introduce yourself and maybe properly correct my pronunciation of your full name. Very good. Honorable chair and vice chair and representatives of the House Committee on Healthcare. Thank you for the invitation to speak today about what our concerns related to mental health and suicide prevention are for Vermont. I'm Dr. Joellen Turallo, the executive director of the Center for Health and Learning and director of the Vermont Suicide Prevention Center, a public-private partnership. And I'd like to thank you for the opportunity to speak today. If this meets the needs of the committee, I would like to accomplish three things. One is to provide a database answer to the question as to whether the COVID epidemic gives us cause for concern with regard to mental health and suicide issues, challenges. Second, to establish what populations are at higher risk and three to promote the strategies that have been identified by the Vermont Suicide Prevention Coalition over the course of many meetings and in collaboration with the Department of Mental Health. We have over 10 years of continuous attendance of more than 40 members at each meeting, representing the concerns of people with lived experience and representatives of state agency and partner organizations. So when I speak, I do not speak on behalf of myself alone, however, on behalf of this coalition. Shall I proceed then with those priorities? Please do. Okay. The first question is, does COVID give us cause for concern? And after a thorough review with the literature based on what we've learned from studies done on past quarantine and public health emergencies, including SARS, H1N1, Ebola, Spanish flu and MERS, the answer is yes. Effects of quarantine include higher incidents of many mental health related conditions. There were reductions in anxiety four to six months after quarantine ended, which gives us some pause for hope that we can address this in a very systematic way. And it is true that prolonged quarantines may be associated with PTSD symptoms and depression up to three years post-quarantine. Another question, are children at higher risk for mental health challenges? Yes, as a result of the pandemic, that is. During SARS, PTSD scores of children were four times higher than those not in quarantine. Another question, are healthcare workers at higher risk of mental health challenges as well as our essential workers? The answer to that is yes. Those who worked in healthcare and experienced the virus suffered increased stress levels, negative mental health effects, including depression and PTSD at three year follow up versus the general public. And there was also an association with alcohol use dependency symptoms in those who were working at high risk locations and quarantined. Another question, are older adults at risk of suicide? This is generally the case with older adults due to a lack of social engagement, anxiety and stress. These are all predisposing factors, feelings of loneliness and disconnectedness and being a burden on family members. And that was true for all the research during these pandemics. They were likely associated with an increase in suicide of older adults. Is the general public at risk? Yes, suffering from the outbreak is associated with increased stress, fear, anxiety, depression and suicidal ideation. PTSD and depression were the most prevalent psychiatric condition at 30 months post outbreak. So moving on from previous pandemics with regard to mental health and COVID, the CDC reported in June that 40% of US adults were struggling with mental health or substance use and were experiencing increased negative mental health conditions associated with COVID. Younger adults, minorities, Hispanic and Black and essential workers are disproportionately suffering from adverse mental health outcomes, increased substance use and elevated suicidal ideation. The rise in mental illness attributed to the pandemic is actually greater than expected. Three times the number of Americans suffering from depression now before then before the pandemic began. We saw an 890% increase in call volume to the disaster distress helpline in April, 2020 compared with the previous April. In Vermont, the number of Vermonters dying by suicide and ED visits for suicidal ideation and our self-harm in 2021, 2020 and 2021 are actually similar to previous years. However, the overall percentage of those visits for suicidal ideation and self-harm have increased from past years. Our LGBTQ and BIPOC students of Black, Indigenous and people of color are at very high risk in Vermont with 36% of our LGBT students saying that they've made a suicide plan compared to 13% of students overall making a suicide plan. And for those attempting suicide, 7% of students overall attempted suicide, 10% of our Black, Indigenous people of color in Vermont students attempted suicide and 19% of our LGBTQ students attempted suicide. Effects of school closures on mental health and suicide and this is national information now cannot be conclusively linked, the rise in youth and young adult suicides which has been steadily increasing over 20 years cannot be conclusively linked to school closures. Emergency calls related to mental health have increased in 40 states for all age groups. And some districts throughout the country are reporting suicide clusters and there is an emphasis on connecting students with resources. We know that students are missing the social nexus that school offers and experts fear that suicide rates for youth and young adults may increase since due to school closures they're becoming isolated from friends and trusted adults at school. And home is where youth and young adults often have the most access to firearms. Every town noted that gun sales doubled throughout the US from March to July when compared with the previous year and coupled with an overall trend in increased deaths by suicide among youth using firearms. 51% increase in firearms suicides in those ages 15 to 24 in the decade ending in 2018. And of particular concern, and we hear about concern of suicidal ideation among elementary students quite a bit in adapting our you matter suicide prevention program down to the elementary school level is an increase of 214% rate of suicide among 10 to 14 year olds by firearm in 2018. Is there an increase in youth suicide due to COVID? They have been rising over the year and currently there is no evidence that the pandemic has led to an overall spike in suicide rates for youth. We have all been working many of us nationally and in Vermont to address this rate. And there is one newly released by the Department of Mental Health Data that I would like to share with you as I start to talk with you about the coalitions identified by the Vermont Suicide Prevention Coalition. And is it possible to share a screen quickly? I think that can be arranged by our assistant. Okay, if you could just make me a co-host for a moment. Yes, you should be able to. Okay, there we go. How does that, can you see a graph? Yes. So Alison Crumpf who I believe you've perhaps had testimony from Director of Quality Improvement. Okay, at Department of Mental Health just shared this with me this morning. And this is percent of suicide deaths who were served by a DA, a designated mental health agency, within the previous year. And what we see here is what I consider a very favorable downward trend from 2012. And we initiated our zero suicide efforts which is Suicide Safer Care with designated agencies in 2014 and 15. So right about when there was a spike downward trend to 2020. Now we have no idea if this is the attributing factor. Right now we have seven of our 12 designated mental health agencies participating in the zero suicide 2020-21 project. A lot of this is due to capacity and due to resources to properly fund such an initiative. I can unshare now and go back to just a few final speaking points. And let me see, I will stop my share. So here are the Vermont's Suicide Prevention Coalition priorities. And I will tell you that these were in a bill that was being discussed last year. And when COVID hit, that was set aside for other COVID related priorities. And also because COVID did lend some resources to a short term to some of this work in which we've been able to initiate a pilot project where we're building the pathway between the seven designated mental health agencies that are participating in the zero suicide project with 17 corresponding primary care practices through that funding, which is really very exciting. And we hope we'll have some really good outcomes for the pathway. So here are the priorities. The first is to create a full-time position within the Department of Mental Health. There is no designated position within state government to think about and address suicide prevention. As you know, suicide prevention tends to be a nexus for many corresponding mental health issues. Thinking strategically about these and how we move upstream is really going to make a difference. This position would oversee suicide prevention strategies throughout the state and maximize the impact of existing programs and coordinate alignment of efforts. The coalition is fully in support of this. The second is to increase outreach of suicide prevention resources by expanding and bringing to scale the National Suicide Prevention Lifeline. I think perhaps Allison may have shared with you some very favorable movement in that regard, I hope. The Nash, yes, okay. The Suicide Prevention Lifeline is soon to be 988. And we will be, I know there has been a committee call to look at the best implementation plan for that. We highly recommend an increase in means reduction strategy, particularly addressing the role of access to lethal means and increasing awareness of safe storage and practices for firearms. Expanding programs that provide mental health and suicide prevention along the continuum of care, which I just spoke about, that would be expanding existing zero suicide initiatives. Targeting at-risk populations with suicide prevention strategies by working with our partners throughout the state who can best reach those populations based on existing health disparities, expanding the creation and evaluation of targeted resources for risks that group older risk groups, older Vermonters, LGBTQ youth and young adults, veterans and our people of color. To expand programs that promote connectedness for youth and families, supporting elder care clinician programs that create connections for our elders and address social isolation and provide suicide prevention presentations for health and education professionals that address populations at risk. There's huge need to expand to families serving foster care to our juvenile justice system and our justice system overall. Really, there's huge room for expansion of our prevention programming. To promote protective factors for youth and families and to create prevention-prepared school communities, there is a recommendation to expand UMatter Suicide Prevention and National Best Practice Program and in full disclosure developed by the Center for Health and Learning and other gatekeeper programs that are being used in Vermont. And finally, the one I can speak the least to is Request Medicare Waiver to Improve Access to Treatment which Allison may already have spoken of and or our colleagues at Vermont Health Care Access could speak to that. With that presentation, I will wind it up and see if you have any questions. Thank you, thank you. Are there particular questions for Joellen at this point in time? Joellen will also turn to you as a continuing resource both with the Department of Mental Health and others. So let's take some questions and let's be mindful of the fact that we have other witnesses as well. Thank you. I'm sorry, Joellen, were you? No, okay. Representative Blackman, Representative Goldman. Thank you. I'm sorry, could you explain the graph that you put up? I don't, I didn't quite understand what it was trying to say. Absolutely. So let me bring it up again. And I have to get to my share screen. So hold on, please. And I should be able to find it. Here you are. Okay, there you go. Can you see it? Yes. Okay. So we have been working, Representative Black with the designated mental health system under the Vermont Care Partners umbrella really for the past five years. Since 2015, when the Zero Suicide Initiative was launched nationally and we learned about it at a national conference and our then Director of Medical Director at Department of Mental Health brought it and determined it should be a priority in Vermont. We had three designated mental health agencies step forward at that time to begin the implementation of the many facets of developing suicide safer pathways to care. This all comes out of data which indicates back in 2018 that 80% of the people who had died by suicide nationally in the previous year had seen either a mental health provider, a primary care doctor or gone to the emergency department within the previous 12 months. So that raises many questions about what is or isn't happening in the pathway to care. Those that data would never be acceptable for other chronic health conditions such as heart disease, cardiovascular disease, et cetera. So this chart shows that since 2012 to 2020, the number of suicide deaths who were served by RDA within the previous year. So those who were seen within our designated mental health system, the number of deaths resulting or not resulting, that is not good language, the number of deaths continued to decrease among those who are seeking help in our mental health system. And so this is very favorable for the services of our system, particularly since 2015 when there was a major spike and then a downward trend since then. So, I mean, I see the positive of that. I'm just, I'm thinking knowing that Vermont's suicide rate is steadily climbing. Doesn't this also show that we're not reaching so what this shows is that we are gonna be reaching? Yeah, we are aiming to ensure that people who need help get into our system of care. This is a huge problem. Is that many and most of the people who die are not in a system of care, a pathway of care. And then we want to ensure that once they get into the pathway of care, that the care is effective, that people are trained and prepared to provide care that has good outcomes. And that requires protocols for screening and tools for screening and assessing a person's risk low, medium, high and ensuring that if they are at risk, screened at risk, then they can get into a pathway for immediate intervention, timely response and effective treatment. Does that help? I think what this is showing. Thank you. I do understand that. I just wanted to clarify that I was looking at the right thing. Well, you've asked a very good question and that is what about all the people who are not in the system of care? This graph only speaks to those who were in the system of care. So what we need to do is, you know, buoy up our system of care, which I know you are striving to address through a variety of channels with mental health and primary care as well. You know, a primary care doctor, the research is very clear. Well, is very hesitant to identify somebody at risk for mental illness and or suicide if they don't perceive effective treatment or a good pathway to care. And so we need to create the pathway between where they're identified, it might be primary care, it might be emergency department, it might be in the mental health agency or it might be in an independent provider setting. Wherever they access care, we wanna make sure there are good linkages to the next step of care and that a good linkage means a warm handoff because when people don't have proper care coordination then they're again on their own and can be at very high risk, especially if they've sought care and there's a break in care. And second of all, when they are moved along a continuum to get care that the people who are there are trained through effective workforce development and using effective tools to meet their needs. Just like we would do in cardiovascular. I'm sorry, I really need to interrupt. We're, there's so much important information but we're exceeding the time that we have. And so I apologize. I will stop my share. You never need to apologize. I know how much you've managed and thank you for the opportunity. But I just stand by to provide any further responses. Right. And I'm concerned only because in respect for our other witnesses, they get to be heard as well. So Representative Goldman, do you wanna name your question and if it can be answered briefly perhaps but we really need to keep moving. Happy, I'm just wondering if you have data or experience whether a 48 hour waiting period for firearm purchases affects suicide? Yes, I know that Dr. Elliott Nelson and Dr. Paul Mangiello, both professors emeritus from UVM Medical Center and Dartmouth Hitchcock Medical Center are better versed in this data and they work closely Dr. Nelson in particular with the Harvard Means Matter Program. I know that within 24 hours that there is some need to really look into that data and I would defer to them and I'd be happy to put you in touch with them. Great. Thank you. Thank you very much. So again, thank you for all your work and there's as with so many topics there's so much more to know and lots of questions many of us would like to ask as well but thank you. Thank you, I will sign off now. Okay, great. I believe Dan is with us from who works as a peer support staff member and Dan I'm gonna let you introduce yourself. I think you've been with us before as I remember and maybe if I'm forgetting that not getting that correct why don't you introduce yourself to the committee? Oh, sure. Actually I have been with you before but this is my first official testimony so you'll have to indulge me any missteps and kudos to you for pronouncing my name spot on. Okay. Representative Lippert and what I'd like to thank you all for including me in today's schedule. I am here representing myself which reflects a number of roles in mental health which I'll discuss later. The topic of my testimony today is community mental health services and within that I'm gonna specifically focus on peer support. In summary what I wanna talk to you about is the power of peer. So first I'm gonna briefly describe peer support peer support workers and peer support services. I'll give you a summary of my background as it relates to peer support services touch upon the benefits and finally give you my call to action. So as many of you may know and certainly Ann is well versed in this at the very least peer support has been described as a system of giving and receiving help based on key principles that include shared responsibility and mutual agreement of what is helpful. Peer specialists use their own personal and lived experience recovering from a mental illness to support others in their recovery. This lived experience distinguishes peer support workers from traditional mental health service providers. So what's a peer support worker? Well, peer support providers are people with personal experience with mental health substance use or trauma conditions who receive specialized training and supervision to guide and support others who are experiencing similar issues toward increased wellness in the spirit of mutuality and compassion. In general, a peer supporter is an individual who's made a personal commitment that his or her own wellness and recovery and is willing to share that what he or she has learned about their own mental health journey in an inspirational way. So what are peer support services? Well, they include a wide variety of activities including advocacy, connecting individuals in recovery to resources, sharing experiences, community, relationship building, group facilitation, skill building, mentoring and goal setting. Peer support workers also plan and develop groups, support groups, services and activities. They supervise other peer workers, provide training, gather information on resources and minister programs or agencies, educate the public and policymakers while all the time working to eliminate stigma and discrimination. So turning to my background to give context for my discussion here about peer support. First I was born in Burlington and I was diagnosed with a major mood condition about 25 years ago in the middle of a career in corporate finance in Connecticut. I am also a survivor of multiple inpatient psychiatric hospitalizations. So for the first 20 years of my mental health journey my modalities of therapy were medication and talk therapy which provided some level of stability but my condition really deteriorated. So five years ago essentially I was forced into retirement and moved to Vermont. Soon after moving to Vermont I discovered a peer support group run by Nanny Vermont and that changed my life. My recovery improved steadily and my mental health stability has been the best it's been in many years. My sustained recovery has enabled me not only to become a peer support worker and volunteer but also a mental health and peer support advocate organizer. So I work as an operator answering calls for pathway support line, the warm line as I like to call it. And I volunteer as a support group facilitator and trainer for Nanny Vermont. In my advocacy work I represent the voice of Vermonters who have lived mental health experience specifically on DMH's adult program standing committee and the federal SAMHSA block grant planning council. Organizationally I am vice chair of the Peer Workforce Development Initiative which among other tasks is creating and delivering training to peer support workers across the state and developing a peer specialist certification program. So that's peer support. That's my background in a nutshell. So what are the benefits? Peer support has been well researched and documented as a highly cost-effective evidence-based practice with a myriad of benefits. Just to cite a few examples in a 2003 study of patients diagnosed with schizophrenia by polar and major depression some were treated with peer support services and others without. The patients who had peer support had better health outcomes and at a lower cost. Moreover, those receiving peer support services experienced significant reduction in drug alcohol use, improved mental and physical health and increased social support for people experiencing homelessness. Further in 2003, the president's new freedom commission on mental health identified peer support as the vehicle for psychiatric survivor, peers, to share their knowledge, skills and experience of recovery. In 2007, the Center for Medicare and Medicaid Services deemed peer support, quote, an evidence-based mental health model of care, end quote and issued guidelines to states for how to pay for peer services using Medicaid. Meanwhile, other research has demonstrated peer support is associated with significantly fewer inpatient and emergency service hours and significant improvements in healing, empowerment and satisfaction. So that leads to my final set of points which is my call to action. First, I'm urging you to make peer support an integral part of the mental health and substance use service delivery here in Vermont. In many ways, peer support is a part of service delivery across the state within the DAs. Of course, entities like my employer, Pathways Vermont and Vermont Psychiatric Survivors, Elysem are run and or staffed by peers. So we have a lot of experience in the state. However, we could do more. People with extensive experience in peer support should be involved at multiple levels of planning and implementation of peer support services within the Agency of Health Services and DMH, the designated agencies and other major health organizations. Next, state statutes governing the practice of mental health professions should be amended to remove barriers that artificially restrict the scope of activities of peer support workers. Further, Vermont should set aside an appropriate percentage of state funds that are specifically earmarked for peer support programs beyond what we have right now. Family and adolescent peer support service should also be further developed and should complement the adult services. Moreover, we should assure that trained peer advocates are included among the groups of people permitted to provide crisis support in emergency preparedness and response plans. Specifically, as we are now looking at the intersection of law enforcement and mental health, we should be looking to the optimal ways to use peer support workers in crisis situations to help establish connections, de-escalate, prevent violates while diverting those afflicted from emergency rooms and from traumatizing locked inpatient psychiatric facilities. In addition to help foster the growth of peer support services, including at small nimble non-for-profits in the state, statutes should seek to minimize the reporting burden while maintaining accountability in order to facilitate service provision and entry of peers into the services environment. I would also urge you to continue to support the peer workforce development issue, which I mentioned earlier, in developing the peer specialist certification. Certification and advanced certification play a critical role in promoting professionalism and in obtaining reimbursement for services, but opportunities for peers without certification should also be available as well. And lastly, I suggest that the peer workforce development mission be funded further to support research on the efficacy of peer support programs and the different structural and training considerations that promote that greater efficiency and effectiveness. So in conclusion, I urge you to recognize, support and fund the power of peer. Thank you. I open it up to any questions you may have. Right. Can I start by saying, I appreciate how powerfully and clearly you articulated both the power of peer advocacy and your call to action. Thank you. Thank you. I will open up to other questions of committee members. Have questions at this time. I would also say that I would be pleased on behalf of the committee to have you join with us at a later time as we review advocacy positions that this committee may move forward through either the budgeting process or the general statutory proposals, a number of which you've touched on. Right. I'd be happy to. Well, I don't see any questions, right? Well, I do see a question from Representative Houghton. Apologies. Thank you Representative Houghton for waving your hand because your little yellow hand got lost in the corner there. No worries. I'm going to call video just for a moment. Do not take this as a lack of interest. I live in a passive solar house and I'm now roasting. Now that the sun has finally come out so I'm going to go open the window. I can't. Dan, thank you for that powerful testimony. I'm just wondering if that can be submitted to our committee assistant so we can have it on records. To ensure that we for the call to action is with us. Would that be possible? That would be great. I'll have to clean up my notes a little bit, but absolutely. That would, you know, even if it's just the, I mean, everything was wonderful, but even if it's just a call to action, that would be really helpful to have with us. Sure enough. Thank you. Yeah. Yes, Representative Houghton, thank you for asking for that because it'd be helpful to have the clear articulation of the different points that you've made for us to consider, which I think speaking for myself, I think there may be a great deal of interest. So thank you. So I'm going to, so it's now 2.39. We have Laurie Emerson from NAMI Vermont and then we have the executive director of Vermont Psychiatric Survivors who I think has also invited someone to testify with him, two of them, two people. And, you know, they were initially scheduled for 3.30 and we said, oh no, we'll probably get there sooner. Of course, then we mistakenly moved it up. But I'm going to suggest that we hear from NAMI Vermont. And then with the goal, Laurie, with the goal that we are turning to Vermont Psychiatric Survivors by three o'clock so that we can at least hear first from the representatives that are going to testify in addition to their executive director who I want to respect the fact that they've made themselves available to our committee this afternoon. So Laurie, that's turned to you for NAMI Vermont. Okay, thank you so much. For the record, my name is Laurie Emerson. I'm the executive director at NAMI Vermont and that is the independent Vermont chapter of the National Alliance on Mental Illness. And as our cornerstone for NAMI Vermont, we focus on support, education and advocacy. And we're a nonprofit 501c3 organization and all of our volunteers administer our free programs that we have for the community, for providers. And we also do many different presentations as well. So I want to thank you for allowing NAMI Vermont to provide testimony to your committee for Mental Health Advocacy Day or week. My comments will focus on two areas, mental health crisis response and telehealth testimony in a psychiatric facility from a community member. So this year's Mental Health Advocacy Day was held virtually this year and we had 250 advocates and organizations there on February 1st. And thanks so much for those who could attend. If you couldn't attend, we have a link. We have a recording of the event and I would encourage all of you to take a look at that. We have a lot of sharing stories towards the end of our day, which I think you'll find of great interest. When a mental health crisis happens, it should get a mental health response. The handcuffing and pepper spraying of a nine year old girl in Rochester, New York last Friday by local law enforcement after a crisis deserved help, not handcuffs and pepper spray. NAMI believes that responses to situations like this family's crisis should be met with well-trained mobile crisis that provide the de-escalation, help and support that people need. And these teams should include peer and family support advocates. A police response to a mental health crisis is not the answer. Police are trained to respond to criminal encounters. We've seen countless times when police respond to a mental health crisis and it can escalate a situation and the likelihood of criminal charges being filed or worst yet, someone is injured or killed. We need to avoid these encounters by having alternatives to responding to mental health crises. Many families or community members do not know or understand what options and alternatives exist for their community other than calling 911 or bringing their loved one to the emergency room, which could be, which should be a last resort and only if someone is in immediate danger to sell for others. Last year, federal adoption of 988 has a three digit number for mental health, substance use and suicidal crises which will be affected nationwide by July 2022, provides a path forward to accelerate better options for communities across the country. NAMI Vermont advocates her state and local crisis systems that combined well-trained call centers with mobile crisis teams that includes peer support to meet people where they are at and crisis stabilization programs. Other states are creating legislation that will ensure a well-funded system is in place once the 988 phone numbers active. Vermont needs to ensure the 988 number and system is comprehensive and addresses three things, mental health, substance use and suicidal crises and not to serve as only a suicide prevention lifeline. We can set up call centers and crisis teams but what next? Where do people go to get immediate help? Do we continue to keep bringing people to the emergency room? No. We need to invest into crisis stabilization programs, a program that allows drop-ins that allows people to stabilize within 24 hours in a home-like setting and then are referred back to the community and follow it up on. Another example of a crisis response model is from Eugene, Oregon, the CAHOOTS program. They've been in existence for about 31 years and they're a non-police trauma-informed mobile response to children and adults in crisis. Last year, out of a total of about 24,000 CAHOOTS calls, police backup was only requested 150 times. As Vermont builds crisis response system that includes mobile mental health crisis clinicians, it is critical that we also include people living in long-term recovery from mental illness to be part of the design, the planning and the workforce. Some people respond better to peer approach and every community and individual has unique challenges and needs and each of those responses needs to be tailored to fit that local environment and that person. So additionally, NAMI Vermont and Team 2 Vermont are scheduling screenings of the Ernie and Joe Crisis Cop documentary and it includes an interactive panel discussion with different communities throughout Vermont and I would highly encourage this committee to join in when we have our next documentary screening and I'll just share that information with you when that's available. What the documentary follows is two San Antonio police officers from the mental health unit and how they approach crisis intervention by de-escalation and diverting people from the criminal justice system. So I hope you can be involved in that conversation with local communities. So we request that the state and your committee continue to establish alternatives to mental health crisis intervention and crisis stabilization which will help diversion from the criminal justice system. So thanks so much for listening to those comments from NAMI Vermont. I do want to include a testimony about telehealth from a patient who was involved in our legislative training and she specifically addressed this one topic and I thought it was important to include that for your committee to listen to. Can you articulate what her testimony is or is that? Yes, absolutely. It's about telehealth in a psychiatric facility and I know you're working on a telehealth bill so I thought this would be very pertinent to what you're working on. So she's a resident from Middlebury and her ask is for support to have on-site inpatient psychiatrists instead of video psychiatric care at inpatient facilities as a normal standard of care. So one of the most difficult issues for her was with psychiatric care during an inpatient stay at Browdoble retreat in 2019. So this was even before the pandemic. When she met with her psychiatrist she was surprised when she was put in front of a video screen having been out of the retreat for a couple of years she was shocked at the changes when she came back with video telehealth being the biggest change and when she asked further about this practice she was told that most psychiatrists at the retreat are no longer physically present and only see patients via video. A rotating practitioner would be there as well but the video practitioner was a normal standard of care in the inpatient facility at the retreat. She was suffering with depression, desperate for help needing human interaction and assistance and questioning her own worth. To treat anyone who was in a critical psychiatric situation with a video screen felt very cold and uncaring. To her it felt as if the hospital didn't find her worthy to have an in-person dialogue. Human interaction is critical and in particular during a crisis. Being alone with a video screen and no physical presence felt inappropriate unsupported and cold. She eventually found a different facility in Vermont where this practice did not happen and the feeling of care and compassion was conveyed through direct interaction. By not having that physical presence it makes people feel alone and unwanted and impacts the crisis even further. Instead of meeting the patient in a manner which has uninhibited the limited visibility and communication through the screen is one more obstacle in the way of psychological progression and recovery. Inpatient facilities require hands-on interaction. We are all human and the more impersonal you make it the harder it can be for someone to actually feel like they are being listened to or cared for appropriately. We need to get psychiatrists back into inpatient facilities with real interactions. There's no substitute for in-person care and it will lead to better outcomes. She would ask that all inpatient facilities in the state of Vermont require as a standard of care in-person visits with their primary inpatient psychiatric practitioner at a minimum five days per week. This would mean inpatient facilities would not be allowed to have video sessions more than two days per week with patients pertaining to the subject of inpatient psychiatric care. Additionally, Nami has heard from other members who were in the emergency room being evaluated via video through a phone camera to be assessed for voluntary admission into a psychiatric hospital. And this was also pre-COVID time. And they found the experience in personal, uncaring and dehumanizing. However, when we hear from members who have anxiety or live in rural areas without transportation or the internet, a phone appointment is very beneficial for them to be involved without patient care such as counseling appointments or primary care visits. So that was the testimony as written by somebody who was involved in our training. And I just wanted to share that with you. Thank you. Thank you. We will take that into consideration as we move forward both on our work around mental health in general and telehealth. Thank you. Are there particular questions for Nami Vermont or Lori and Nami Vermont? Not seeing any at the moment. I want to thank you. Thank you for joining us, making yourself available and sharing your valuable insights to our committee. Great. Thank you very much. I believe we actually are now prepared to welcome Karim Chapman. And I'm not, Karim, I'm not sure I'm pronouncing your name properly. I don't think we've met previously. Welcome, but I think I see that you're with us on the screen. I saw that you had joined us just a minute or two ago. Yes, yes, yes. Okay. You were close. You were close. It's Karim. Karim, Karim. Okay. They're Karim. Yes, you were close. So I mean, you guys actually had a time, which is awesome. I did have two people who were gonna be testifying with me. They were scheduled at three o'clock. So I believe how it was gonna work that you guys will call in. But I guess I can start, you know, a little bit of time. Let me ask you this, Karim. Yeah. Is it, would it be valuable for you to be able to be telling us about your work with Vermont Psychiatric Survivors with the other friends, colleagues, on the Zoom screen while you're doing that? Or can we go forward hearing from you and then have them join us when they're available? What makes best sense for you, Karim? Well, I am okay with either way, but I did see a comment that you guys, somebody asked me for a five minute break. So I guess you guys been here for a while. So I'm okay with the five minute break. That'll give you guys some time and I can just get started and the other folks will be on with me. That's okay. I think that's a plan. I think we've made a collaboration. I love it. There you go, there you go. Okay, great. So five minute break. Let's come back on just before three. And again, a reminder. If you need any reminders, check the news. But a reminder to go off video and off screen. Please, not for the same reasons, but anyway, go off video off screen so that we're clear that we're not online right now. Okay. And just to explain, Karim, we have several members whose internet connection is very shaky today. So they're not going to be on screen. I thought, so are your folks ready? Are they gonna, they're gonna call in? Is that my understanding? Yeah, there was some connection errors happening, but I think Colleen is handling it right now. Okay, Colleen's picking on it, okay. Yeah, so I could begin whenever you're ready and hopefully towards the end of my presentation, they will be on board and I can pass it to them. Well, let me start by saying welcome. And I'm also, because I think this is the first time you appeared with our committee since you've taken on your new role. Correct. Perhaps let's do a round of introductions. I think that might be appropriate for us as committee members. I'm gonna start with myself, Bill Lippert. I represent the town of Heinsberg and I chair the committee. And you in fact, of course, know our vice chair, representative Donahue. Sorry, Anna, kind of not this, but I'm gonna just pass it around the screen. I represent black. Would you introduce yourself and then pass it to another member and not just the new members? Hi, Karim. I'm Alyssa Black. I represent Essex and Westford. And I will pass it to representative Cortis. Nice to meet you. Nice to meet you. Thank you, Karim. It's nice to have you here. My name is Mari Cortis and I live in Lincoln representing Bristol, Lincoln, Monkton and Starksboro. And I'll pass it on to representative Paige. Nice to meet you. I'm not sure where you passed it, Mari. I didn't catch it. Representative Paige. Paige, okay. Representative Paige may be having internet connections. I'm going with representative China. Okay. Hi, Karim. My name is Brian China and I represent a piece of Burlington because Burlington has 12 representatives and the piece of Burlington I represent is Chittenden 6-4 which is most of the East District and part of the Old North End of Burlington which is where I actually live. So welcome to our committee. It's great to meet you. Nice to meet you. Representative Peterson, would you like to go next? Yeah, it's a good afternoon. Art Peterson, I represent Rutland District 2, towns of Clarendon, Wallingford, West Rutland, Timmeth and Brocker. Good to meet you. Nice to meet you. I'm going to keep just back and represent Goldman. Good afternoon, it's a pleasure. Welcome to our committee. I represent Wyndham 3 which is in Northeastern Wyndham County, Athens, Brookline, Grafton, Rockingham, part of Westminster and Wyndham. Nice to meet you. And representative Burroughs is off video because she has a shaky internet connection. Are you there, Elizabeth? Would you like to say hello? I'm here, hold on. Let's see if I can get it to... Sorry. Hello. There you go. Hey, how you doing? I'm Elizabeth Burroughs. I represent, I live in West Windsor. I represent Windsor 1, which is Heartland, West Windsor and Windsor. Nice to meet you. Nice to meet you. And I think that takes us to Representative Page. If you can hear me, Woody, I'm happy to have you introduce yourself. Otherwise I'll introduce Representative Page who is from the Northeast Kingdom part of Vermont and Newport, I believe, representing Newport. So we have a number of other folks on the line with us and I see there's someone possibly on the phone line, but I think we could begin, Karim, and we'll have you and someone else is about to join us by phone, I believe. So we'll have you begin and then have you manage introducing others who are with you. The time is yours. Awesome. Well, let me first just start by saying thank you for the time to testify and to kind of tell you a little bit about VPS and what we're doing. And I also want to say I am a survivor myself. I've been through psychiatric facilities as a young man. I saw my father killed by police that really sent me through a very traumatic time as a young man and it put me in a role where I made a lot of bad choices and it wasn't until I ran into a peer support person in my life that really helped me to get into a better place. So I'll just start with that short brief background. So yes, I am the new executive director for Vermont Psychiatric Survivors. And for those who don't know, VPS has been around for about 38 years and our mission is to provide advocacy and mutual support that seeks to end this psychiatric coercion, oppression, discrimination. So what that simply means is that at a time where in the 70s really when people in agencies, the systems kind of looked at people with mental health issues as some kind of disease or people who are just crazy, a group of folks got together and said, you know what, we need a place for people who are survivors, for people who are going through some mental health challenges and need support. So this organization was developed and I can say till this day, we are still supporting and providing support for all survivors throughout the state of Vermont. We currently are operating within 10 hospitals and as we all know, the pandemic has not been making that easy, but we are virtually in most hospitals, it's been a little bit of a back and forth, but some progress is happening there. So what I want to get into right now is just saying and get into some points of issues that I think VPS stands by and speaking on behalf of survivors in the state, that's okay. Towards the end of my presentation, and I don't want to talk a long time, I want to save a lot of time for the two folks who agreed to be brave and speak and give their truth. I don't want to talk a lot, but I do want to kind of hit some points and pass it on to Annette and Greg. So issue the concern, peer services expansion is one of the major parts of the 10-year vision, but there are no expansions of services proposed at DMH. But peer services provides do not have a voice at DMH and I would stop right there. I think it's very important that the peer world, definitely VPS, that we have a voice. I think a lot of years have gone by where we have not had a voice. And we think if we had a voice, a part of DMH, it would be very helpful with transparency and it's having better guidance and support where we need it. Okay. VPS is supposed to be providing patient representation for all involuntary patients in 10 locations around the state. Now, hospital oversight. We know that DMH has a lot of oversight, but we think that it could use more support around that. We were to have more support specifically with DMH as oversight and involve peer organizations that would be so helpful, so impactful and sky's the limit of how much work could get done if we had that oversight and support from DMH. Not saying that there aren't people there who are not supporting us, like Trish and Morning Fox who are always there by phone, call, or email. They're always there to support us, but we do want more of oversight and a voice within that system to give better support to the peer organizations. Okay. DMH does not monitor hospitals regarding volunteer site care. Seclusions and restraints happens to voluntary patients, but it's not reviewed. Overall use of seclusion and restraint in Vermont hospitals is growing instead of declining. We're seeing more of that declining than going down. And we look at that as an issue. Once again, just putting it back on the peer support and what the impact that we have in working with patients while they're in and when they're coming out of these facilities. Again, the collaboration, the connections that we need from not only this body, but also DMH to be a really good role and play a really good part in connecting and supporting us. Okay. Community needs are being ignored in favor of institutions. DMH's own report shows that people are stuck in hospitals because of lack of housing. Some are discharged to homelessness. Now we think that that is an issue. There is no reason why we have someone in care and can't have a healthy transition when they're leaving and going into a home or some kind of support. Having someone leave a facility and be homeless is just not right. And if anybody thought about what our own family in that situation, how would you feel of your family words that's kicked out and put on the street? So we really hope that people take a look at that and really understand the support that we need and make sure that that's being done differently. Okay. Hospital Medicaid reimbursements should not come from DMH's budget because they seek money, I'm sorry, some money out of the budget for community services and it's not partially, I'm sorry, partially with other hospitals budgets. There's so much money going around that most organizations are fighting for it. Why does it always have to be a fight to do the right thing? Why does it always have to be so much controversy around supporting and helping people when they're out in our care? So again, I think we can do a lot better. I think this body has not only the authority, but I think the potential to really step in and play a role in supporting us around this. And I'll just say one last thing and I really wanna move on and let the other people talk or I don't wanna talk too much, but Bill H-46 and the committee addresses some important issues. We support it. One, it addresses some of the gaps in site survivor voices, requires in law for site survivors to be a majority on the DEA hospital and state adversary committees. Requires all designated hospitals to have them right now only level one are required. The restraint and seclusion oversight committees should also be site survivors and advocates. Currently, there is only one site survivor position. The rest are mostly the hospital providers. Once again, that speaks really to the peer voice not being involved and at the table of these conversations and policy decisions. So once again, we need to be a part of it. We wanna be a part of it. And we are here doing the work. Even during these dark times, we're out here doing the work and we really need support from this body and everybody who has the authority and some kind of powerful pen to make some powerful things happen for people who care. Okay, again, I'm a survivor. I've been through it. I've been medicated. I've been told that I'm gonna be in medication for the rest of my life. And today I can report I'm not on medication. I'm holding a job. I am progressing in life and I'm a person who was in a facility and was told that I will never get better. So again, let's take a look at how we can do a better job in supporting not only the hospitals but organizations that are very small in trying to do this big work. Okay, so I think you guys have the power and authority and the means to do it. So please, I wish to be supported and for all of us to be supported around these efforts. So with that, I'm gonna be quiet. And I'm gonna allow, I'm gonna introduce two very powerful individuals to also survivors, people who are conducting their own work in the community with their support groups throughout Vermont. So I'm gonna introduce Annette and Greg and I'm gonna let them, Annette, I don't know if you wanna go first, if you're there Annette. I think I see her number. Annette, are you there? You may be muted. In order to unmute from the telephone, you need to press star six. So if you heard that Annette, you gotta press star six. You there? Okay, this is Annette Denio and Greg and I have conferred about this and unfortunately he has an appointment at the Cancer Center getting results today. Pray God. But, so I'm gonna speak for both of us for our groups through United Council and we facilitate through the CRT program, the Crisis and Rehabilitation Treatment Program. And we both are, we're introduced into this mental illness psychiatric world by traumatic brain injuries. Greg ended up in a coma for several days, come out and his life was not the same. I had a parasitic brain infection, come out of stuff and my life was not the same. We both had careers, everything going for us and we had to change. We both were hospitalized and we have been many times in institutions. United Council is helpful, but we have to both say the peer programs, not the therapy or the medication have helped us as much as these peer programs have a hundred fold. We haven't been in the hospital in years. We now facilitate peer programs and we've done that for years because there's nobody understands more than ones that have been there. And I always say there's, we all have the same boat, but many different oars. There's many avenues that we have had to travel no matter what it is. And we are thriving on this. The COVID hit us hard. We've had to switch our group. We ended up doing a phone service just like this through a community care home where there's 16 clients and most of them have attended our groups. Greg does a teaching group and he's added an activity on the end and we have an incentive price for whoever comes. I do a social group. I used to do it on Fridays, a social club, complete games, socializing, getting people to speak that never spoke, people that smiled, people that talked, people that learned the difference between a good pick and a bad pick because they had no idea because mental illness, society just crushes on it. And we get it. We've been there. We're peers. Our groups together, I ran an average of 25 people in my club, enough where we had to stop because we were over fire capacity for the room. Greg's group ran anywhere from 10 to 15. Now that we're in the community care home, we've involved the whole house because there's 16 there and there's four others that are per se mental illness, but they need to support. And we get a lot of thank yous, a lot of, I love yous, a lot of, you haven't left us. And we're still there. We're still doing it. We love them. We are peers and I am so into this peer support. I was a charge nurse for years in geriatrics and a whole other realm, you know, a lot of the same, oh, sorry. A lot of the same issues, but we are, I'm sorry, my dogs, we've become quite used to dogs, no problem. All right, they're two little ones. Greg, I have them on the phone now. I'll let you go right after me. But we're so used, so dedicated to this that we wanna keep fighting, but we need the funding. We do need the funding because we found with our groups, this indeed, they tell us it has kept people out of the hospital. We have precautions with one of the groups. I did a depression and bipolar. We rated people, are you a one to a nine? If they were lower than a three, they got therapy. We used to call United Council and they come evaluate them, but the admissions have gone way down just because we stand together and we call and there's a friendship in the building. There's a friendship outside of the building. We even get together for barbecues. And it's just a wonderful thing. And we are very grateful, but we do need support. It's nice to have money for supplies, for teachings, even for Greg when he does an extended lesson on his group, which is Hot Topics. And you need a little bit of support for that, for all the supplies. But I'm grateful for doing this and I continue to do this because this keeps me out of the hospital. I get just as much from it as Greg does. And I'm gonna hand the phone over to Greg. Thank you, Annette. Annette, will you stay on the line then so we can ask questions to both of you? Yeah, we have the same phone. Yeah, we have both of them. That's my understanding, yeah. So let's hear from Greg and then maybe we'll have, if there are questions, we can address them to either of both of you. Hi, my name's Greg Berter and what would you guys like to know? Or what's the, is there a question? Yeah, let me ask, I'll ask you a couple of questions, Greg. So first of all, welcome. I'm glad you're willing to be with us. Your colleague and friend Annette was telling us that she had, in fact, she was herself a survivor and told us just a short version of her journey in hospitalization and now work being supported through peer support. And she said that you had some of the same experience or similar experience and it would be helpful to hear- Yeah, I am myself a survivor. I, my mental health issues came about because of a traumatic brain injury. I spent a lot of time in the hospital, probably a good five years total out of 13, about 13 that it took me to finally get back to be able to live in, you know, a regular life and a safe life. And as far as the peer support goes, peer support has to be like a number one thing. If you have somebody that has mental health issues, it makes it a lot easier to understand because of having the same experiences. And like Annette was saying, we're committed to this. Our people that count on us, they're cooped. I wouldn't want to be in that position that they're in. And we never stop doing our group. I mean, we, you know, once the COVID hit, it's like, OK, so, you know, what's our way around it? You know, and, you know, we ended up coming up with a plan and we implemented the plan and we've been rolling right along. Actually, my group has gotten probably a third more members than I had previously when I was just doing it over at CRT. And one of the things is, you know, I mean, in the beginning, I started this group out of my, out of my own pocket and I would continue to run it out of my own pocket. The only problem is, is I can't put a group on like I would like to without the support of, you know, the pop grant and that kind of thing. You know, I just, I can't do a righteous group that I would like to do that, you know. I'm especially now I was putting in extra stuff for the guys, you know, for the people, the members to read, you know, when they were, you know, stuck in a situation in the house. You know, they had something to turn to, you know, and that's, you know, I'm lucky that I'm able to take, you know, some complicated, you know, medical jogging and stuff like that and turn it into something that people can understand, you know, and they don't have, you know, any kind of thing like that. You know, we have a great group, even though we're not together. I mean, you know, everybody looks forward to it. You know, people are coming out of the woodwork that we never even knew before. You know, I mean, they were like, you know, and standing in the shadows and, you know, now they're like right up front, you know, in the bright light, you know, wanting to, you know, wanting to do more and wanting to know more. So Greg, can I interrupt you and ask you, I think Representative Donahue has a question. Perhaps you know her. I don't know if you and Greg know each other yet. And Donahue is the vice chair of our committee. And I'm sorry to interrupt you, but it's hard when we're on phones and know when to jump in. But I'm gonna let Ann speak for a minute and then I have another question if you have a minute more. Yeah, so Greg, before you got on the line, Kareem was talking about how VPS also is active with advocacy. I was just wondering if you could very briefly tell the committee about your work with the hospital when they opened emergency room space for folks. You mean the psycho-hell incident? Yes, that would be the one. Why, well, my advocacy work, I mean, I've been doing it for quite a long time, but one of the highlights was, they built some rooms over here at the Bennington Southwest of Vermont Medical Center for people that were waiting to go to Brattleboro up to another facility that had mental health issues that were having a crisis or whatever. And I only heard about it and I happened to need to go to Brattleboro. I was having a crisis and I went there and they said, you know, well, you'll be able to go into the new rooms that they built and everything. Well, you know, I was all excited about that. And I said, you know, this is great that they finally, you know, completed it and everything. I went in there, it was so bad. It was like a cell prison. It actually made me worse. And it was luckily that I knew the crisis teamwork that came and, you know, he was able to, you know, say that I wasn't a threat to anybody or myself. And, you know, I was able to leave because I couldn't stay there. It was just horrible. So the next day, that night I had done some research and I found how Brattleboro had won an award for, you know, what they had done and, you know, decorating for the patients, you know, making it more homey and stuff like that. And I took some of that information. And, you know, my own experience, I went to see Miriam Cushan, who's the patient advocate here at SVMC. And, you know, I explained the whole situation to her. Well, you know, time went by and, you know, I wasn't getting anywhere with anybody about, you know, trying to, you know, do something in the lines of making, you know, the place a little bit more homey and, you know, not so stuck and sterile and, you know, even more anxious, anxiety-growing. So I had written a letter about it called Psycho-Hell Hidden Away at Southwest of Vermont Medical Center and I sent it to Wilbur once he first started. And that sparked a little bit of investigation from DMH and they had found out that some things weren't what they were supposedly or what they were told. And they took my advice and they had, you know, done the whole place up really nice and we got invited to see it and to make sure that it was, you know, up to standards that, you know, if there was anybody that had any other, you know, ideas on any other way to make it, you know, more inviting to stay there instead of, you know, like laying in the corner and biting your nails or whatever. Thank you, Greg. Thank you for your advocacy. So can I ask Greg in a net? I wanna ask, are you volunteers at this point or are you compensated? Are you paid for your work leading these groups at United Counseling Service? Well, we were paid through a pop grant but the last time we're paid was last May. So we're doing stuff out of our pocket. We have to, we can't tell people no. Cause again, we've been in the hospital and Greg and I both had, you get out of discharge to the hospital. There was nothing there. I went through it for 10 years. There was nothing there which would cause me to break down back in the hospital, get out, left to stand alone, break down. And that's one reason we're such advocates for these peer groups. People get out of the hospital. They need to know what they can cleave to. Annette, can you just clarify to answer the question? When you were being paid, it was a stipend. You weren't on a salary, is that right? No, we were on the pop grant stipend for what we did while we still do. Okay. I appreciate that you're continuing to volunteer but one of the goals, I think we heard from someone earlier with part of their call to action was more funding for peer support work such as what you're doing. And that's part of what I wanna make sure we understand in our committee. Thank you. Thank you. Thank you for allowing us to have this time to speak up about this. And it's really hot to put across in words how much this means to us and how much this means to the people that we're helping. So I mean, I can say it's only one of the things that I, one of the things that I like is spiritual annoying. We'll never have a written understanding and that's kind of like what this is. But you know what's deep down inside that you're doing the right thing. And just a little bit out from here or there is it makes a whole world of a difference. Yes. Can I tell you that you've both been very powerful and effective with your words in communicating with us. So this, I want you to know that you have come across in a very positive and important way. Thank you very much. Yeah, absolutely. Thank you. I'm going to turn back to Karim. And Karim, I don't know if you have, maybe you have a question for the folks that are on the line yourself or I'm going to turn it back to you for some comments. And then at some point we'll bring this to a close for today. Oh, thank you. Thank you. And then Greg, you guys rock. Thank you. Thank you. Thank you. Yeah, you got it. So I just wanted if possible to share my screen one quick, for maybe less than a minute that's okay. Absolutely. I think Colleen, our assistant can help you with the screen share. Okay. I think you're a co-host now from what I see. Okay, let's go. I'm good. Okay, you guys can see my screen. I can see the screen. Don't see. Yeah, there we go. Okay. So I just got to take a look at this. You know, this is really what we support and what we stand by. Let me just make sure you guys can see it. So I'll give you a second and maybe a minute to read it. So what I'm taking from that, Kareem, is that this is part of the Vision 2030 plan? Correct. Correct. But it's more aspirational than real right now. I hear you. So did everybody get a chance to see it? I'm gonna take it down. I think most people have, yeah. Wait, wait, wait. Oh, sorry. It's okay. Go ahead. I was too slow. It's okay. And we can send a copy. We can send a copy. Yeah, I can send it. So with that, thank you for letting me share. So again, I mean, you heard from, I'm sure, some very powerful people today. And again, we would love support from this body. You know, we can't stress enough the importance of getting it right. You know, there are people suffering and people need to know that they have people in their corners and their backs, not just us, you, right? So you guys are representatives and I'm sure your constituents are definitely looking for you guys and get it right as well. So with that, if there's any questions from me, I'd love to answer it. And that concludes what I needed to say for the presentation. Great. Thank you, Kareem. I'm going to open it to any committee members to ask Kareem particular questions. I see several right now. I'm going to go to Representative Peterson and then Representative Chena. Yes, thank you. Kareem, how many, I have a couple of questions and you might have mentioned it and I didn't catch it, but how many people a year do you serve, do you think? Or maybe you know exactly. So obviously because, okay. How many people do you serve in a year, do you think? So because of the pandemic, obviously all numbers are down. We are aware of that. But anywhere between 50 to 100 plus people that we serve. And remember, the reason why we're servicing that amount of people is because we work through the hospitals. You know, if we had more funding to expand the program to be in the community where we really want to be, remember, we only have a contract through DMH to do patient representation, right? So that allows us only to really be in the hospitals. So all the extra work that we want to do or we kind of stretch out is very spread thin because we don't have the extra funding to do the extra stuff, you understand? Okay, that was my other question. When do you get, who does fund you? I mean, where do you get? DMH. So our source of funding is DMH. And to be quite honest with you, like I mentioned before, it's very hard to seek extra support and help. I have literally under 10 staff covering their entire state. And we're doing it, but it's not easy, you understand? So the demand for funding is needed. I can't stress it enough. Okay, thank you. Thank you. Representative Chena? Yeah, I don't have a question, but I wanted to just say something to our guests to just acknowledge what I've heard that as a person myself who survived mental health issues and who now is a provider of treatment and working with people, I'm also an activist working with people to change the systems that caused a lot of the problems we have. Then I just want to acknowledge that something that I think Greg said about how it's a spiritual thing, about how connecting with people, how we don't always know why it works, but it works. And I think we need to honor that, that as human beings, we're not meant to handle things alone. And when we're cut off from people, it's hard, and that we actually do need other people to heal. And that's how we're wired as humans. If you look at the science too, not just our spirit, but what science is showing us. And so the work that you all are doing is so important because in the end, people need people. And you deserve to be paid for what you're doing as much as it's the right thing to do and we all should just do the right thing for each other. You're dedicating a lot of time and it's an important piece of the system of care and you deserve to be paid and you deserve to be funded more for the work that you're doing at Psychiatric Survivors Cream. So I just want to acknowledge that. And we are 11 out of 150 house members who are part of 180 people. But I am one out of 11 who will continue to advocate for you and just want to express gratitude for everything that you have done and just leave it at that. Thank you. Thank you for your support. Appreciate that. Thank you. Thank you. Representative Peterson, I see your hand is still up. Or is that, yep, no, I'm representing Goldman. Same as your hand up again. No, okay. No, I have to ask a question. That that's a new hand. Sorry. Yeah, thank you so much for your work. It sounds really important. And I'm new to the mental health system. So thank you for your perspective. We are hearing a lot about designated agencies that exist throughout the state. In my area, it's HCRS. And I'm just wondering is there a relationship that you have with designated agencies and is that a potential source of funding for you or does that not make any sense at all? So great, great question. So I'll just paint you a small picture and give you an example. So I worked for two years with the mental health as their first peer support specialist on their crisis team. So I actually went out, met people in the community, worked with the police, did everything with the crisis team. So this is big controversy around the peer world and the clinical world. Who has the best solution? Who does it the best? I believe that everybody plays a role. I believe the clinical person plays a role. The peer support person also plays a role. So my intention in being executive director for VPS is to bridge that gap, to make the collaborative connection that says, why are we fighting? Why can't we come together and meet in the middle to figure out what needs to be done? So to answer your question as well, I have great connections with other DAs that I've been working with. Again, during this pandemic it's been very hard to not be able to go into hospitals but still work with people while they're in the hospitals. So it was a big struggle to get our tablets and figure out how to get the money to even purchase tablets to go into the facilities. We had to kind of do a lot of penny pension, but yeah, there are organizations who are willing and have been connecting with us. There are some who have not, but we're working on it. The retreat is doing their best. There are still struggles there. There is still a lot of work to be done with the retreat, but we have some kind of momentum. We still want to understand why bathrooms are locked. We still want to have answers to that. We don't know yet, but that is happening. And if there is a reason for that, I think the public and the people should know why bathrooms are being locked as an example. So again, collaborations are possible, are happening, and I am definitely all for it. Thank you. Thank you very much. Thank you. Thank you. Well, this has been, as is often the case, the most powerful testimony comes from people whose lives have been directly impacted. And this has, I think, been demonstrated again this afternoon. I have a question too for you guys. Oh, you do? Okay, fine. Well, I'm sorry, just one question, one question. Sure. Anybody can answer it, it's free of all. So, and maybe this is a hard question, but I'm gonna go for it. You go for it. What is the consensus in your group right now of support for whatever? I just, if someone could just say, because the community is very unaware of what the conversation is. But if someone can just maybe describe real briefly, what is it that this committee wants to do for people that have the experience or the disconnect between DAs in the peer world? What is it that you guys wanna have happen? Well, it's a great question, and it's the question that we need to address ourselves. And we haven't had that conversation. To be honest, Karim, we haven't, so I'm just gonna give you a little bit of information. We're a brand new committee. We first started getting together like four weeks ago, five weeks ago now. Okay. So we've been getting to know, there are new members to the committee for whom this is brand new information. There's folks in the committee who've been committed to peer support for years. And have lived experience. And so we have, so we're in the process of listening, and then we're going to have to turn to the point where we're gonna say, okay, next week, we're gonna start talking about money and the budget and what we're willing to advocate for, what we, what are our priorities? And peer support is gonna be one of those questions. So I can't answer that for you conclusively right now, but I can say this, that I think you have a number of members of this committee who already have been committed to support for peer support in years past and are very, continue to be very sympathetic. I think this committee may be one of the most supportive places you're gonna find in the whole legislature. Okay, let's go. Seriously, but I don't want to pre, I don't want to prejudge what our party is because there's a lot of people who need a lot from us. But this is, I think for some of us, high on the list of priorities. So I will, I think when we get to that point, I think we should communicate back to you. And I will be all ears and ready and ready to go. Okay, good. Thank you for asking that very directly. Yes, thank you for the opportunity and for all the new members. Thank you and just I hope that everything you heard today really will persuade you in a way of different kind of support other than just hospitals getting support because again, there are other organizations doing some great work and we should not have to fight over the same pool of money to do some alternative different support work. Yeah, so Karim, I see that Representative Page has a question. Oh, let's take another question, Representative Page. No, I'm more dumb with questions for the day. I can't do it. Okay, well. You got to pay him more before he'll ask you more questions. Well, that's that's my question. It is about money. And you did talk about some sort of pot fund. Pot grants, yep. Yes, could you, do we have any idea how much that grant was for? Sure, sure. Yeah, so the pot grants and the support grants are a few grand where where people are have to meet criteria's on, for example, running a group or having some kind of work related to survivors and how they can support survivors. You know, that we have another group where people are looking to do artwork to support people through their trauma, you know. So we will reimburse them. We would love to be able to give them the money to get it going, but we don't have the funding like that. So we reimburse them, they submit an invoice. So that's how it goes right now. That's how it's been for a while. We don't really like it. We work with what we have. But again, like you just met, you heard from Greg and then that they have an amazing group. They used to be supported and we want to support them more, but we can't in that way, you know. So again, this is another reason to say we need the funding to do these. And members, that's only one group. We have multiple groups going around the state, okay? So you heard from two amazing people out of a whole bunch that we have. So I'm gonna just, I'm just in monitoring this. I know AJ Rubin is with us and I had heard indirectly from AJ that he had said, look, if I need to get bumped in order to hear fully from the folks who are actually doing the peer support work. So he's hanging in there. I- Hey, AJ. But I do wanna, you know, check in with him and maybe give him a little bit of time still. But Ian, you had to, I don't know, Elizabeth, Representative Barrows had a question. Then Representative Downhill. Representative Downhill, go ahead. Yeah, thanks. I just wanted to, if that was the question, Karim, it's about $3,000. Yes, correct. That a group would get as a pop grant, right? Correct, correct. Yeah. May I ask, may I say something about our pop grants for Greg and I? My group, social club on Friday, there was like 25. The first half was games. The second half was a meal. And I didn't do, I did good food, salad. We had everything from goulash or spaghetti to stuffed pork chops, baked chicken, a real healthy meal, and then desserts and beverages. This pop grant, even with that and running this stuff in prizes. And then with Greg's group, the same thing. We were able to really pinch our pennies and we were able to stretch that money for five days a week for these groups. And we also did a basket bingo a couple of years in a row when we raised a lot of money for our groups. Of course, this year we couldn't do it. But that pop grant to us, it's really essential to keep these going because we are on limited income now. And it's just hard, it's very hard, but this is so, so needed. And it's not just for us, it's for all the 25 that we're still connecting with Monday through Friday and even on the weekends. Thank you. I'm gonna turn to Representative Barrows and Burroughs. And then, I think we're gonna stop with my psychiatric survivors and, but Representative Barrows, you have a question. She's not on the screen because of her internet. Yeah, again, I apologize about my internet. I would like you to clarify just briefly about the seclusion and restraint just so that I get it square in my mind. Your group goes in and they talk with patients who have been through seclusion and restraint at facilities, is that right? At the designated. Right, so sometimes that is the case. So, on behalf of VPS, we are totally against restraints. We think that there are other alternatives other than restraining someone. We believe that when a person comes into a facility, if they need to, that they have some input and some say in how they are treated if they get to a level of, would they need that extra support? But to make a decision for them, where you have to put hands on and restrain them in a way that they are uncomfortable with, there are other alternatives. So, if that helped answer the question, we go in, if someone says they didn't like how they were treated, the patient representative will kind of investigate, ask questions, kind of get to the bottom, go through the grievance process to find out if the grievance process was done correctly from beginning to end and resolve. So, we play that role as well. And the patients there know that. They know that they have a representative at VPS and that is our role, while we're there also support them when they leave. Okay. Did that help? Yes, that is, okay. But, on your list of issues of concern, you also mentioned that the seclusion and restraint is not reviewed by the DMH. Is that also, did I hear that wrong? Yes, yes, yes. There is no review mechanism that we believe in. We think that it should be more. And Donahue can talk more to that as she wants. I see your hand going up, but I didn't have a conversation, honestly. No, I just wanted to clarify. They do for involuntary patients, but if you're a voluntary patient and you're restrained or secluded, it is not part of the oversight. Wow, okay. Not yet. There you go, not yet. Not yet. Right. Check the bills on your wall. Thank you. And that is definitely a bigger conversation for a couple of minutes. I appreciate you clarifying that for me. I thought I heard that correctly. I just, yeah, I wish you could see my face right now. Well, thank you. Well, listen, thank you guys. I appreciate this time and hope to hear from you in the future. Thank you. Thank you. You've been terrific. Thank you. All right. Thank you Donahue and to, Greg. Greg, thank you. Donahue and Greg. Thank you Donahue and Greg. As well as, okay. AJ, I wanna just check in with you. It's, I'm gonna be candid here, AJ. I'm not sure there's anything you can say at this point after a long day that's gonna top what we just heard. And it's not to say that we don't wanna hear from you, but I'm gonna be honest and say, I like to practice, invite you back at a different point in time. I think we might do well to either invite you to, nope, it's my best judgment right now. I'm gonna exercise it as the chair. I think we should say thank you. And I think to, I think we should, we should finish our testimony and ask you if you might come back. Whatever, I'm at your service. I usually say, and I say that with full respect because I just think that it's been a really long day and my experience is that it's often good to just when you've heard powerful testimony to not get in the way of it. And I think that's what, so I'd be happy to have a conversation with you offline about that. Oh, as you noted, I understood this was a possibility and I am a big supporter of emphasizing the peer role and I am grateful that your committee took this up and I agree it was very powerful and I am at your service as your mental health care ombuds person under Ed. So please invite me back whenever it's convenient and thank you for your time. We will and we will want people to know about the role you play, but I think this is the right decision from my point of view right now. Thank you, AJ, for your service and for your understanding about that. Can I play? So folks, I think we've had a very full day and a very long day, a very full day and I honestly think it's a good thing for us to call it to a close right now and thank the folks, everyone who's testified for us today. And Dan, I see you're still maybe on the line with us. Thank you, Dan. I wanna acknowledge your important testimony as well earlier. So I think with that, I'm going to suggest that we adjourn for the day. Then we're back on tomorrow morning as a committee after the floor and what you're going to be experiencing more and more of is how we have to move from topic to topic and we're gonna come back to our deliberations now on audio only, which Representative Houghton has been continuing to work on following our committee discussion yesterday, work on with Jen Carby and Lori's gonna lead us through some review of where we are with that tomorrow morning. Is that we're in line for that? Yeah. Yes, we are. Okay. And then we have rescheduled Julie Tesler to the afternoon. I realize it's gonna be a long Friday as well, but I think it's important for us to hear from Julie about the designated agencies. We heard a lot from the department. We've now heard a lot from peer support and some others who are doing other important work. And I think all of that will stand us in good stead for then looking at budget issues as we come back to issues around the mental health system of care next week. So.