 Welcome back folks. This is House Corrections and Institutions Committee. We're shifting gears a little bit this afternoon. We're working on a couple of one section in particular of S3. We do not physically have the bill. It is in House Judiciary. We're doing a drive, what's called a drive by. In that we are just looking at a couple of sections in the bill and making our recommendations to House Corrections, House Judiciary Committee on behalf of our committee. So this afternoon, we're going to be looking at section five. And if, if that goes really, really quick and maybe, maybe we could do just like a quick 30,000 foot look at maybe section six. But we're going to schedule more time next week for section six, which is the forensic unit with all the players. So I don't know if it's Commissioner Baker wants to start or Morning Fox. We section five asks for an inventory of an inventory and an evaluation of the mental health services that are provided when someone is in corrections. And we, we, this committee did quite a bit of work on working with DMH and DOC. Four years ago, I want to say, on really developing helping them develop an MOU for services that will be provided within DOC when there's folks with mental health issues or even the SFI folks. So we have also a new health contractor vital core that we now contract with to provide our medical services and our mental health services. So, I think part of the questions that we really need to address in section five is what with the inventory is it possible to do the inventory and the timeframe for that and what the inventory and evaluation would encompass. So, is it Commissioner Baker that goes first or yes, okay. Welcome Commissioner. Good afternoon everyone for the record, I'm James Baker I'm the interim commissioner of corrections and thank you for your time. I know you had a busy day here. From corrections and standpoint on section five of S3. We don't have a lot to add, we're not opposed to doing this work of the inventory and doing some comparison of about what we provide for services we actually think it will be healthy and helpful. We don't have an issue with the language about what's being required for us to do from our part I don't. I mean, I think the deputy commissioner from mental health will weigh in on mental health but from our standpoint, we don't have an issue doing that. One concern we have, and I have sent to House judiciary message because I didn't get a chance to testify today there, because they ran out of time. We're looking for a little bit of an extension on the time of the report back. As the legislature is going through we've got several reports that we're going to end up working on. Again, and trying to manage those become challenging. This one could take a little bit of work in the sense of inventory and the services, working with vital core, working with mental health and reporting back. So we're asking for, you know, ideally to be a 12 month period extension from that November. First I believe this is the date yes, November 1. We would ask for a little bit more time on that. By the time the bill passes and gets out it's going to be June, and you know that literally leaves us about four and a half, five months to do. Through through the summer months which is a challenging time for everybody because of vacations. So when you ask for like a 12 month was that would that be 12 months from like June and July or is it 12 months from now. I'm just trying to get a feel. I'd be good with 12 months from now. Sure. So that would be in April so that doesn't leave much time if there's any legislative work that needs to be done. Okay. That's what corrections is on section five. Okay. And let's go to morning Fox deputy commissioner damage and so if you could identify yourself for the record as well morning. For the record, morning Fox deputy commissioner Department of Mental Health. I'd like to thank the committee for giving us a few moments to discuss this. As commissioner Baker mentioned. This is a aside from other studies and things going on. This is an important study. And I think it's just coming at a, an auspicious time in regards to pandemic and pandemic winding down and how everything is changing and how we operate and reshifting back. And given some of those complexities as well as making sure that we do a good evaluation of what, you know, getting the, the sense of the inventory of all the services going on, and then being able to really have a good comparison of the, the work in the as that's the, the charge of part of this study is to ensure that we're taking a look at services available in the, in the community, as well as the functioning and effectiveness of the, the MOU. And so I would agree with commissioner Baker that just having a, a, about a four and a half five month timeframe to do that. I think would, would result in a subpar evaluation. So, you know, we, we were in support of the request for, for an extended period of time. And I understand that it would come mid session if we were to go for a year from now. Next year. However, I think this committee and others would prefer to have a thorough and valuable assessment done than a more timely assessment that's not as thorough or complete. So looking through a legislative session and where you are between the mid March and mid April, would mid March be workable for folks instead of mid April. Or is that too tight a timeframe, or maybe a draft report by mid March or is that still too much. I don't know. I'm just, I just know at the end of middle, middle of April, we only got to have about a month left of a session, which is a little difficult. I'm just trying to put some options out there. And I, as, as the deputy commissioner said, I hear your concerns. I think mid March is better than November. We could work with, you know, with the committees to do that. It's just as the deputy commissioner said, besides going in the summer, you know, we're in the planning process now coming out of the pandemic and that's going to take a lot of resources over the summer to, to orchestra us getting back to whatever the new normal is going to look like so any amount of time that we can get I think is going to be beneficial, because as the deputy commissioner said I, and I said this in the beginning, think this is an opportunity for us to take a good look, provides us that opportunity but I want to make sure it's just not a matter of giving you a report back for sake and give me a report back. So we had some questions Karen you had your hand up and it's down so are you okay. Now I have a question. I'm just automatically going to go to you. Thank you both and this is this question is to help myself understand things too I'm wondering if each of you could share your kind of perspective or understanding of why this assessment is needed. The inventory and then the assessment on it. I'm trying to understand the big picture and so I think it would be helpful to have each of your perspectives. I think to begin with the, not the, not the trolling deputy commissioner under the boss here, but I think he may, I think he from my conversations with him he may have a better understanding of the history, and then I can weigh in from corrections to standpoint. All yours morning. I am thankful to the commissioner for this opportunity. We were there with you to morning. No, and this this pre existed in an original iteration of this bill from the past biennium which was actually s 183. And, you know, I think it's, I think this this piece of the legislation was was put in. I can't remember exactly who was the driving force but I think there's, there's always concerns about, you know, how are services in contained environments, like a correctional setting. Those compare to the services that individuals like ourselves may access out in the community and wanting to ensure that the, the access timeliness and types of services that any of us could access. So should people who are are incarcerated, and that they have a right to the to access to those those types of services, and in a timely fashion. And, you know, so I think that plus the fact that there's a new health care provider within corrections, I think is an opportune time to kind of take an inventory of where things are at. And what's changed over the course as the new contractor has come in, and where things currently stand, and what if any improvements still need to be made. So represent don't I think that's the history which I didn't have because it preceded me right and so from my standpoint, I didn't understand the history until I met up with the deputy commissioner folks from mental health yesterday to prepare for today. And from where I stand on this I'm going to go back to what I said earlier, it's exactly what the deputy commissioner was talking about. There's always this question about how well we're doing with individuals that are incarcerated. And, you know, especially during the pandemic. I think this would be a timely opportunity for us to look back, especially in this pandemic environment. You know, we've talked in this committee before about the choices we've had to make to keep the facilities clean to include putting people in quarantine coming into the facilities. You know, and it's no pretty way of saying they're isolated. And, you know, it's, it's not easy. It's not easy for the staff and it's not easy for the individuals. And so I think it's a timely opportunity for us to work with our contractor mental health, and really see if we measure up to what the outside standard is the community standard is on how we get mental health support to the individuals that are incarcerated. And if it shows that we're not doing what we should be doing. It's our opportunity to fix it instead of waiting for a tragedy. And I think we're fully supportive and be very, very supportive of looking at the outcomes and figure out how we can even do better. Thank you both I appreciate it. Sarah. Thank you. Madam chair, thanks and thank you. Deputy commissioner and interim commissioner. It's, I have a couple of questions but I, the first one is. The question here is about looking into a forensic, the need potential need for a forensic facility. And it's specifically for people here, where the language is in here is, you know, so Sarah, you've kicked over to section six. Oh, okay. Okay. Maybe I should wait, wait off. I'll hold off on my question then. How many folks in this, this may be may not be able to answer this but I'm going to categorize it in terms of SFI sir seriously functionally impaired because that's more the definition that's used within corrections. How many do you know how many folks are in that category at this point at all. I don't know the exact number a few weeks back. I had asked for that number and, you know, I'm just going to give a number please don't hold me to it. I want to follow up with point. And it was somewhere around 35 ish, you know the populations 1234 today. So preparing for this I had asked staff to kind of give me an update on what's going on in this space. And, and, you know, what we've done on our own is to really put a team together. That's taking a look at folks who fit into that category and measure that up against our responsibilities with a da. A process that's going on right now there's a team looking at that, just to make sure that we're doing what we're supposed to be doing. So I can get you that exact number. I'm just giving that number off the top of my head and my, my memory may not be what it used to be and I may not have that number. And I know that we do have a copy of the MOU that the committee can take a look at to when, and that has been in place morning. That was put in place three years ago, two years ago, MOU three. I'd say it's been about three years. I think you're, you're right around that. And just a reminder for the committee to the SFI designation covers folks, you know, who have mental health or severe significant mental health impairments, as well as intellectual developmental disabilities and others as well. So, but yeah, you're, I think you're, you're right, Madam chair that the MOU has been in place. I helped craft it. Probably three or four years ago, somewhere in that framework. Anything else. Now for about four and a half years. Yeah. So, okay. So, I think that was, I think my question I was going to ask is actually on this topic. So, MOU. MOU, but like, you know, if the, if there are 35 people where are they housed throughout our system, or they in our men, are they, whether it's DOC or mental health, like where, where are these people now. So representative coffee, they would be throughout the system. But I don't, I don't want to give some, I am asked, I just text to ask for a report. And so I can get back to you on that, because I want to be really accurate about that. And, you know, we do have a focus on mental health in the spring field facility, but folks are throughout our system. So I will get, I will get that information to you. So it's, so it's from, it sounds like when you say the system, you're sounding like it's the, it's in the correctional system so they're not, and they're not at the state psychiatric hospital or at the Brattleboro retreat or I just want to be, make sure that. So, remember when you asked me that question you're asking me who's in my custody. Yeah, no. They're in my custody, they're in our system, which is the collection system. Commissioner squirrels custody I'll let deputy commissioner answer that. Representative coffee to try to explain a little bit better. The designation of SFI does not in turn mean that they need placement elsewhere. And so the part of the MOU is that we work together with our partners at DOC should it should an individual who's housed within corrections require hospital level of care, whether it be voluntary or involuntary that we provide facilitation of that consultation on cases, you know, things of that nature, and such. So it may be possible that a person who's designated as SFI at some point during their, their incarceration may be hospitalized and may return. You know, but the designation of SFI does not necessarily mean that they require outside the walls treatment, if you will. Okay, thank you. Scott and then Marsha. I'm not sure if this is the right time to ask this but I'm curious what services are provided to people with that designation within the correction system and and Howard. Are they integrated with the rest of the population are they segregated. I'm just curious about the whole thing. So, you know, it's hard to say are they because some cases know some cases yes. Right, the pending with with our medical contract. And again I'll get you the specific language, but with our medical contract with Centurion. We do they do provide mental health on site services for individuals. But remember this is not evaluations. This is more about support at the clinical level, right just checking in on people and checking in on the welfare when it comes to their behavioral health. If we are aware of people that have underlying issues such as depression. You know that steps up how we follow their case internally just like we would follow their case with medical. Follow their case as a result of that with the medical team in conjunction with the mental health workers that work under the vital core contract. Okay, I. Yeah, I guess I'm just wondering whether we're trying to sort of help help these folks get better or is it just a maintenance kind of situation or. I'm curious about the degree to which a correctional system is is is actually a place for housing folks who are who, you know, who have these kinds of issues and related issues, you know, trauma substance substance use, you know, all of those issues that that make people run afoul of the law and do bad things but but then anyway I'm not being very coherent about this. Well, you know I think I think representative Campbell you're describing what the challenges in our system. Yeah, yeah, folks end up in our system with all of those, and we try our level best to provide the services to them. You know, when I was preparing for this yesterday with, with, you know, Deputy Commissioner Fox, you know we talked about the fact that if you're, if you're seeking out some type of mental health support in the community, you may wait for weeks five weeks to get an appointment. You put a slip in inside our system that you want to see somebody. You're not wait for five weeks. Now I'm not going to promise you're going to see him within an hour but you know we try very hard to get those services there. And many of the folks that we end up with. I think this is why this. I think this is why the report is going to be helpful. You would a new contract to validate what I'm being told, and to validate what I think about the level of support we give to those individuals who have underlying issues like that. But many of the folks that come into our custody, do in fact need that kind of support. Yep. Okay, great. Thank you. Okay, Marsha. I just want to address something to the Commissioner Baker, and it really has nothing to do with this but I just want to thank him on one thing. And that's for the article and digger today that expressed how many people refuse to get shots, because I've been getting emails, and now I have something to throw back up and then I appreciate it very much thank you. Representative Martell I always appreciate your support in these hearings. It wasn't, it wasn't the best media day yesterday but I appreciate that feedback. No, it wasn't. I think one thing for the committee and Commissioner and Deputy Commissioner and please correct me if I'm wrong. But I know in past testimony that we have received whenever we've been dealing with the SFI population mental health issues. When someone who is incarcerated reaches an acuity level. That goes beyond what do see can handle. There is an agreement with the Department of Mental Health that the person can be transferred to the state hospital in Berlin. And, and that that is there. In order for the person to be stabilized. And once they're stabilized, then they do go back to the correctional facility. So that may happen a couple of three times a year that was our testimony a few years ago I don't know if that's still the case. But I'm going to leave it at that. So is that still the case that that does happen. And as it's it's not necessarily as straightforward. There's, you know, some, some bit of complexities to it. But, but you're basically, that's that's the correct kind of pathway, if you will. You know, do see is working with an individual, they may bring to us at DMH that they have an individual that they think meets criteria for voluntary or involuntary hospitalization. They may facilitate those assessments those evaluations for that level of care need. And then once that's confirmed, then we again will help facilitate either admission to the Vermont psychiatric care hospital the brow bro retreat or, or another inpatient facility. And then you're exactly right. And then the person is stabilized. And then at that point, they would return back to corrections, assuming that they still had, you know, Department of Corrections connection. We have had times where, you know, people sentence, you know finishes while they're hospitalized and then they discharge from our facility as opposed to from a correctional facility. And, you know, that that type of, of timing, but your, your madam chairs is exactly right in the general concept of how that works and refresh my memory when they do move to either the psychiatric hospital care hospital in Berlin or the retreat are they under dual custody in terms of they're still under DOC custody but now they're also under mental health or is it just under mental health. It depends on on what status they go to the hospital. If they go voluntarily, then they still have that that soul custody connection to DOC. If they go involuntarily, and they still have that corrections connection, then they kind of have that dual status. Like I said, we've had that time where the DOC connection may end as someone's, you know, sentence wraps up or something of that sort. And then they'd be under the soul custody of the, of the Commissioner of DMH. Madam chair or something else I want to add short of someone moving from a correctional facility to mental health facility, you know, the MOU. I mean, there's a lot of conversation that goes back and forth between us and mental health on a regular basis. And, you know, you all know I'm fairly new I've been using this excuse now for 15 months right I'm new, but I'm running out of that because I'm supposed to know what I'm talking about. There's a lot of conversation that goes on on individual cases that we rely on mental health expertise to help us understand how to manage a particular situation. And then Commissioner to when you're getting the numbers for how many folks for the SF on, it would be good to see how many of those are sentenced and how many are detainees that might be helpful as well. So kind of now slides us in a little bit into S section six, which deals with the forensic care working group which includes the Department of Mental Health and DOC and I want to do a deeper dive into this next week. But while you're both here if you've got a few minutes. I don't know if you want to weigh in just real quickly. I'm not how to start it because one, one place we need to start as a committee is understanding what a forensic unit is. And I know we had Katie McClinn in yesterday, our legal staff or lawyer, talking that there's two, two ways of getting through a forensic one is through the simple procedure and the other ones through the criminal procedure. And, and or through the courts, not the criminal but through the courts. I think we just need some basic understanding of when we're talking about the forensic care here in section six, which path are people coming in on are they coming through through the civil path, or are they coming through the courts. I don't know that's where I think I want to start very, very basic. If you can help us. I'm a little confused at the, at the comment that someone comes into the forensic system through civil or, or through that that process. Forensic mental health is about people who are involved in the criminal justice system. So what we're talking about forensic there's there's a couple of places of forensic that someone might, if we're talking about who would go to a forensic facility. I think there's a couple of options of how we might look at that. And this is part of what I think the study needs to determine. One is when the court orders competency insanity evaluations. Is that the location where those evaluations can happen. Also, when someone is a detainee or serving a sentence within corrections and need psychiatric hospitalization. Would that be in a forensic facility, or would that be at a general psychiatric hospital. Again, I think these are some of the things that need to be discussed at the work group. One of the things that we run into at the Department of Mental Health is whenever we have an individual who's been ordered hospitalized through the courts. That is criminally justice involved. We need to treat their mental illness. If someone's been adjudicated as not competent to stand trial or been adjudicated as not guilty by reason of insanity. Because of those adjudications, they, they can't serve in a correctional setting. And the Vermont psychiatric care hospital and in fact all of our psychiatric hospitals in Vermont are CMS certified and joint commissions accredited. Which means that we have to follow the conditions of participation in order to receive the federal funding that helps pay for these institutions for these facilities. The Vermont psychiatric care hospital has an operating budget of over $20 million a year, most of which is Medicaid federal dollars. The issue with that is that part of the conditions of participation to receive Medicaid funding is that individuals who receive care at a place like the Vermont psychiatric care hospital have to only be there for psychiatric care. When patients treated and are seen as stabilized and no longer needing hospital level of care. It is incumbent upon the department to discharge them. And then, from a practical standpoint, we then run into the issue of, let's say, as an example, someone is alleged to have committed a extremely violent crime. And they're found not guilty by reason of insanity, or not competent to stand trial. We treat them. And let's say six months later, they're doing well enough that they've stabilized, they're on medication, clear or clearer, but no longer need hospital level of care. I would dare say that I think there's, there would be concern if then we turn around to say, well, we now have to discharge them. And so Vermont is an outlier when it comes to the concept of having a forensic facility that can monitor not only mental health needs, but public safety needs. There's really only a small handful of states that can probably count on one hand that do not have a general funded facility for these types of cases. But if we were to continue to hospitalize an individual after they no longer meet the kind of criteria that CMS lays out for need for hospitalization, we run the risk of losing the funding, either partial or completely for that facility. And so this has been something that I've testified on a number of times and I'm quite passionate about that. One thing that Vermont is lacking is the concept of a facility that can bridge the gap of both mental health needs, as well as public safety. My past experience aside from my eight years at the department here and 25 years of mental health. A half dozen of those years I worked as a managing director at Bridgewater State Hospital in Massachusetts, which is a forensic facility of sorts. And that in any way shape or form I am looking to mirror or bring a Bridgewater like facility here, but it's just an example of that other states have this type of facility to bridge that gap. And so that's the, the, the tightrope and kind of difficult dance that DMH has when we're talking about forensic cases. So, is it also true? Well, I guess I'm going to ask the second question first. In the situation morning that you just spoke about down at Bridgewater, but also maybe up here how it would play out. Under whose jurisdiction would a forensic, and I know that's what this working group would look like, but under whose jurisdiction is it? Would it be DOC? Would it be mental health? Or is it going to be a whole different entity? Who would, because they're not convicted, they're not serving out of sentence. So whose jurisdiction would it be under? And they're not going to get Medicaid reimbursement because they're not going to be seen as in a mental health, they've stabilized. Right. No, you're right. And, you know, Medicaid would look at them, they would fall under Medicaid's definition of inmate. And, you know, Medicaid's definition of inmate, which we're constantly kind of butting heads with Medicaid on, you know, Medicaid has taken a stance at some times where that anyone who is court ordered for treatment, they consider an inmate. So that could even be, you know, civil folks, you know, as you've mentioned, and so that's been an ongoing, you know, negotiation slash discussion with CMS. So, from my research and from my work experience, many states, they do it differently. Some it's run by the state's Department of Mental Health, some it's run by Department of Correction, and frequently it's kind of a joint effort between those two entities. Again, because you have the public safety concerns, but you also have the mental health needs of the individuals. So, different states have different things. There are some states that have instead of, you know, the doctor deciding this person no longer needs to be here and so we're going to discharge that they have a board made up of psychiatrists, doctors, victims advocates, and others, similar to what might make up a parole board to make decisions on when a person is discharged and to what type of services. And so these are the types of things that it's my hope that that's what we really delve into into the forensic study group. This is my early plug in now for more time that it's, you know, shall start by August one and shall have a report by November one. I think just just to talk about a facility, we're going to need more time, let alone competency restoration programs, let alone. Notifications and other pieces and such like that. And so I'm putting in my early plug, you know, I know we'll talk about it next week, but I'll put in my early plug now that we're going to need some significant time again. I don't think this committee nor we do Vermonters any justice by doing, you know, a half-hearted evaluation just to meet a timeline. Another issue that was percolating out there, I believe a couple years ago, because some cases were sort of dismissed down at the state's attorneys level for folks that there were two or three cases in particular thinking they wouldn't have wouldn't be able to prosecute, either because the person could be deemed insane at the time of the crime or incompetent to stand trial at the time of the trial those two separate things. And so then it gets shifted over to mental health. And if the person is housed at one of our mental health facilities either at the psychiatric hospital in Berlin or the retreat. They're under department of mental health and mental health is not required or able because a HIPAA to notify the public. When the person has been stabilized and when they are released, where if the person is under DOC custody, DOC is required to notify the victims, the public. There's more access to where that person is being housed and for how long, then there is in the mental health world. And that's another rub here. Yes, and I think that's earlier sections of S3 address a lot of that. And you know where we're looking at an individual that gets committed to the Department of Mental Health as incompetent to stand trial. As long as the charges remain and they are not dismissed. That should the department seek to discharge that individual from its custody, or from a secure setting that we would notify the state's attorney that was prosecuting the case and or attorney general if they're the ones prosecuting the case. So that victims can be notified that a person is going to be discharging from a secure setting or discharging from custody altogether. It would also include for individuals who are adjudicated as not guilty by reason of insanity that we would make that same notification. And that's not going to get HIPAA or anything. And that's a that's a great question. We've done a lot of a lot of work, ledge council our own council, as long as there's criminal charges that remain open. We think we're good. Many other states have similar laws requiring just that type of notification, and it has not yet to this day been challenged by the by the federal courts at all. And that is a violation of HIPAA. And so, based on how other courts have been doing, other states have been doing it and other jurisdictions. We feel fairly comfortable being able to go forward with that. And the, and the folks who are found not guilty by reason of insanity. That's really such a small number of individuals and how kind of the courts work here in Vermont. So we really don't don't think so. Plus, the amount of information that we're giving is very minimal. It's really just enough for people to know the person is being discharged and that they're no longer in a secure setting. The other provision that most folks have testified about concerns with HIPAA is for those who have been placed on order of non hospitalization as a result of being found incompetent stand trial or not guilty by reason of insanity. And that the courts would be notified if someone was not in compliance with that order. That is fraught with HIPAA concerns, because now you're starting to talk about actual treatment and the treatment that people are engaging in and what they're doing. It creates a conflict between the treatment providers and those they're trying to provide treatment with as kind of being, you know, almost like a, you know, a probation officer, if you will, you know, and a huge aspect of what really helps engage an individual in treatment is that they build a trusting therapeutic relationship. And it's really difficult to have that relationship be sustained if, you know, you missed an appointment. Yes, saying, All right, well, we've got to call the courts. You know, that kind of thing, even though an individual may be doing well but circumstances happen. People miss a dose of a medication or missing appointment. My, the Department of Mental Health as well as disability rights Vermont, as well as state's attorneys and others are all suggesting that that on each language be struck from the bill and just be included as part of the study to see if we can do that and if so how questions from the committee. Alice, I've got a question. Yep. I guess I would put the question out to any of you that are testifying and I'm sorry that I was late coming back into the meeting I had another meeting I had to be at. But why do you think we are only one of three states in the country that does not have a forensic unit. My honest opinion is that it's, it's, it's, it's a costly endeavor. It's general fund money. You know, even if we're talking about a fairly small facility, whether it's repurposing of an old older facility or building a new one, there's going to be that cost, you know, the capital costs which I know this committee is, you know, well versed in, but then you have the operating costs. And, you know, for example, a 25 bed facility Vermont psychiatric care hospital is a $20 million a year over $20 million a year operating costs that is not a huge hit to Vermonters because the primary bulk of that is paid for by Medicaid, and if we don't get that facility, we won't be able to get that Medicaid match. And so I think the reality is, it's, it's a dollar, it's a dollar thing. And I think that that's a, a, that's a tough thing to swallow. That's, it's, it's beyond it's not cheap. Right now and understood. Do you, and is Jim Baker still with us as well. Right. Okay. Do you both feel that it is a need for the state even, you know, considering I do understand the cost of it but do you both feel that this is a facility that's needed. You might want to hold judgment on that until the study comes back. I don't know. Yeah, I guess I see the deputy commissioner. I'll give my answer. My answer. I'll follow up with you. Yeah, my answer has been this way for years that I think Vermont desperately needs a facility of this nature. I don't think we need a, you know, necessarily a 25 or 50 bed, you know, large type institution. But I think there's always going to be a handful of individuals. That will come into either commissioner bakers or, or our systems through the criminal courts. You know, I want to be, be clear, you know, that people with mental illnesses are much more likely to be a victim of a violent offense than to commit one. However, it does happen. People that can happen. And then, I think it's an incumbent upon us as, as the state that we provide good care, and with an eye to public safety at the same time. The system we have currently, we provide that good care. And then what someone is, is found. If a facility or incompetent to stand trial once treated, then what? And so that's, that's why I think there needs to be, you know, I've said this on the record before and I'll say it again today. That yes, I think we need this type of, of a facility. I think what's important is who's going to run it, how it's going to be run, how big it's going to be. The facilities and buildings that can be repurposed or does it need to be new, all of those kind of questions. But at least in my mind, I'm going into the study going with the thought that, yes, I think we need something. What exactly that looks like. I think we need to look at other states, how they're doing it. And what's what's happens in one state doesn't necessarily work here. Where we're another state like other places where unique like every other state will say they're unique. But our laws are different than, than other states and their laws are different than ours. And so we need to be be thoughtful and mindful of the type of facility, how it gets run the type of services. And how individuals will be treated and how it gets determined, you know, when their release should happen. I think part of it also is engaging in competency restoration programs, because I think people have a right to face, you know, their accusers. And, you know, it's, it's not uncommon that people are found incompetent to stand trial. And at that point charges get dismissed and and it's done, except in, you know, the most serious of cases. And so, you know, I think that's a disservice to individuals, because they don't they have a right, you know, just because someone has a mental illness and it's found incompetent to stand trial. They have a right to to be able to go to court to be able to work on their defense. And whether that's an insanity defense, or just I didn't do it defense and not guilty. I think they have that right. And right now the way it operates, we don't have a competency restoration program. And so I think that's another part of the study that is really important that influences how a facility like this would work. I'm going to represent Morris. Yeah, I'm new. But, you know, again, I don't. Well, and as serious no, obviously, you know, the deputy commissioner is well person is now just unbelievable in this area, because of his background and he's a, you know, I think the committee ought to listen very closely to his wisdom based on his background. What I'd like to add to this is, similar to what the deputy commissioner just said, is that from where I sit being in the system, 45 years and looking at this, it's all of a sudden you get to a point that it's that what he said that then what, and then victims are left hanging again, again, the individual has a right. And I also think it's an opportunity based on the little bit I understand about the forensic approach for all of us to learn as much as we can about mental health and what benefits would come out of the work that's done there for us to better understand mental health and the stigma that goes with it. And, and especially within the system. So, the little bit I've been briefed up on it the little bit I understand about it. This isn't the best interest of everybody that some type of forensic process gets put in place in order for us to get better in Vermont and treating everyone with the level of dignity respect and making sure the justice system works for everybody. And so I, that's where I am and I think to study, you know, corrections to give a little peek into what I'll talk about next week. Corrections is all in on supporting mental health on being part of that study to figure out what's the best step forward for us to figure out our forensic piece because right now, everybody's frustrated when something bad happens, and it just ends. And I think it's, it's a real weakness in the system, and a lot of people start pointing fingers at people, and it doesn't serve anybody well, as a result of that. So, again, my limited knowledge about forensic that's where I am on the conversation. I appreciate both of your comments. Thank you. So we have another question, Kurt. Yeah, I'm, I have two questions one. We had act 78 back in 2017 which required the establishment of a forensic mental health unit. By July of 2019. I don't know what happened with that that MOU that we was established then was supposed to be temporary and that we were supposed to have a plan for putting together a forensic mental health unit. So I'm trying to figure out what happened to that and why that didn't move forward I'm also trying to figure out how this relates to the do see feasibility study which is supposed to come back and specifically states that subgroups, having to do with mental health, it's supposed to look into those sub one of the those as a subgroup and figure out a bed count, and what kind of facilities costs might be needed for that so is this redundant are we doing the same thing twice or something we did three years ago are we going to do be in the same mess again where we require something and it doesn't get done. It's a little different Kurt because the the mental health unit that we were talking about with corrections. The folks are there. I don't think they're at the stage where they've been evaluated to be incompetent to stand trial or insane at the time of the crime. There's a real difference there who you're talking about what we worked on prior for for that mental health unit that we worked for folks with SFI or mental health disorders, but they're not at the level of not being able to go through the court system and be adjudicated. That's what I believe is the difference. I think for us we're talking about folks who are in the correctional system. Some of them have sentences they're carrying out. Some of them are detainees. They've been competent to stand trial, they've gone through a trial, or they have not been deemed insane at the time of the crime. It's a different mental health. That wasn't for detainees as well. Somebody detainee who comes in and has a mental health crisis while under the custody of the Department of Corrections. And this thing that we worked on years ago didn't have to do with getting them the help that they need. There are different. There are different mental health issues. There are different mental health issues. There are different mental health issues. There are different mental health issues. They're not at the point that they were insane when the crime was committed. And they have not been deemed incompetent to stand trial. That's those are the two avenues for forensic. It's my understanding. My memory is a little foggy from back then, but I think it was referring to more folks who are sentenced or, but there wasn't a competency or sanity question. I think it's maybe some of that SFI population and providing a more robust, if you will, mental health system within corrections. And, you know, I'd have to go back and review it representative Taylor just to be to be clear and to be honest. I remember if we're talking 2017. Was this also the time when we're we're also looking at the possibility of standing up another facility and that there was the whole different discussions of up in the St. Albans area. Exactly. Yeah. But the 12 blue forensic that is separate than what we worked on with the MOU right looking at the mental health services within DOC those that was a whole separate population. It just happened to be part of that campus style project that Secretary go Bay put on the table. I haven't, I haven't, I haven't I've tried to, that's why I asked where this other MOU is because I have one MOU and you're talking about I gather different MOU. And I'm trying to figure out how these relate together. So are we talking about two separate forensic mental health units, one for people who are in corrections and already sentenced and then another one for people who are determined to be insane at the time of trial. Or are we talking about one for both. I think that's how that's. I think that's part of what the study group will be trying to grapple with. How are we defining that forensic population. Is it solely for those with competency and sanity issues, or is it also for those detainees or sentenced individuals who may have a psychiatric crisis requiring hospitalization. And would they also be served at a facility like this as well. I think that's, that's the piece to be discussed. I think that's a part of it. In some states, again, some states like here, someone who is serving a sentence or as a detainee and requires hospitalization goes to a general psychiatric hospital. And like the state, Vermont psychiatric care hospital, the Browboro retreat, you know, that that type of thing. In other states, individuals who are detainees or serving a sentence. They would go to a forensic facility where there's also that that other population of the folks with incompetence to stand trial or sanity adjudications and serving of that way. And there's there's arguments for both sides as to why one is better than the other or why one is worse than the other. And I could probably argue myself on both sides for quite some time, because there are there are different points on each side as to why it's, it's, you know, why it might be better to have them go to a general psychiatric hospital. Everyone should be treated the same, and we should all receive the same services and everyone should have access to, you know, same levels of care. Others have concerns that, you know, should, should people who are incarcerated be receiving care with, you know, you or me. You know, if we need to be psychiatrically hospitalized. And so I think that some of those types of things are what what informs those those kind of statewide decisions as to the, the actual population to be served in a forensic facility. I think those are the types of things that the study will will come out of. I think just even the correctional study, you know, is talking about what's the level of services and access. The concept is that folks who are serving time or a detain have as good of access as someone in the community should have and types of services, etc. And so if we're truly able to do those things, you know, then the conversation is about, you know, what population should be served at a forensic facility as as we've been discussing today. Okay, so, so the feasibility study which I gather we might be able to see next week, which should also deal with, at least within the corrections population of forensic needs or forensic mental mental health needs would inform this group coming up and that would help to make the decision then or is that is that the idea how does this fit in with the feasibility study. If I can take, if I can take this piece, I don't represent until I don't see us. You know, and again, I'm getting into an area where I'm not an expert, but please make a distinction if you got someone in my custody that is at the level of care that they need to move to a forensic hospital. So I can't mix those folks into some type of setting, if they're designated, if we have other folks in the system designated SFI. So what I'm looking for in the current feasibility study is creating the proper space to manage the programming around the folks that we have in the system now that are SFI, not someone that needs that level of care. I hope this helps, you know, make that distinction. It's not that maybe the study committee working on the forensic piece doesn't come back and make a recommendation. And we'll have time to deal with that because the next step we're talking about right now with the feasibility study is do we put, you know, do we take the 1.5 million over the next two years in the current budget to make the next move towards what we're going to do with the primary focus on replacing the women's facility. What I'm worried about is we can't lose focus on the women's facility in the feasibility study. I don't think the intent was to be talking about creating forensic space inside what we create for new space in as a result of the feasibility study if that makes sense. There's a big difference between what Fox, what what Deputy Commissioner Fox is describing on the forensic piece and I know I'm starting to get pretty close outside my expertise. There's a big difference between that and who we have in our population now that we serve. They may be designated SFI they may not be, but we're providing them mental health services. The current setup of our facilities, I've already said this, are do not render themselves to the type of environment where you should be managing that population. That's what we're talking about. And we take a look at the feasibility study. I'm hoping I'm helping you and not confusing. I may have a better idea of that current next Tuesday we're scheduling Tuesday afternoon we hope for the Hawk report. So it may help clarify some of this. Is that going to be available before Tuesday for us to look at. We're not sure yet because there's a lot of data. And there's hope that it might be able to be maybe on Monday but there's a lot of data that's being assimilated right now. And we are working on having a joint meeting with Senate institutions committee next Tuesday afternoon is what we're working on to schedule. Just one more. Just again, if at all possible I would like to be able to see the study. At least 24 hours before we hear a report on it so that we can. I mean, the study that came back in Maine was 350 pages which I'm imagining is similar to this and some say it's going to be pretty comprehensive and I'd like to have some time to look at it before. I'm actually going over it in committee just a request. People are working as hard as they can. So there's no promise is when it will be available prior or not. And if it's not available prior. And we go through the joint meeting will be working on it some more so it's not going to be the only time that we'll be looking. Okay, good enough. Thanks. So, Sarah, and I have to scoot out because my carpenter is getting ready to leave so Sarah is going to take over for a second. And Sarah does have a question I hope to be right back shortly. Thank you manager. I have a question for both of you commissioner and deputy commissioner as we're looking at section six in the bill. I'm wondering a couple things are, is this too prescriptive or are there right the right ingredients in here about what the working group should focus on. I was one of the things that jumped out to me was a specificity of looking at a program or model in Connecticut. Or, you know, so I'm wondering if that's a really kind of a broad question or that is this too specific or too limiting or is it the right ingredients or are there things that should be made more open or, or added in. From, from DMH's perspective. I think it's fine in that sense and when you're talking about like, you know, is it too prescriptive, you know, I think. I've heard some testimony about, you know, it's a little too prescriptive you shouldn't, you know, that could lead to a bias. If you have things in there like including the Connecticut's psychiatric security review board. It's fine if that's taken out. That's really not something that, you know, we will look at various models, regardless. I think that language actually got, got put in when we're having some of the early conversations about this bill. And just that it was something that we had noted and it been something that we had looked, we had some information on. And so it was, it was really just part of a conversation, I believe with actually Senator Sears. You know, yes, we want to look at places like the Connecticut psychiatric security review board and what they do, you know, it's a very different model they have a similar one to how Oregon does it. And, you know, we want to look at things like that. And so that language then appeared in the legislation, but it's not something we're married to. And if people have concerns about, you know, that type of language and just leave me at a bit more broadly. That's completely fine from our end. Okay. That's, that's, I'm sure there's something terrific in Connecticut. You know, my, my thought without being an expert but I'm imagining that there are things in other states to, you know, that you want to learn from. Earlier today I testified about, you know, some issues, you know, connected to this bill and was referencing statutes and language in the state of Wyoming. And that's not in here, but you know, that's, you know, so I really just feel like it's incumbent upon us to really look at, you know, all the various models that are out there. And if people do have a concern that it seems prescriptive or could lend to to a bias in the assessment and evaluation, then I think we're very comfortable with with that that being that type of line language taken out. Otherwise, like the right ingredients are in here for what you'd want to be looking at. And this is either of you could respond. Yeah, no, we've, we've been really pretty good with it. You know, I think, you know, the member, the members of who would be included in this. You know, maybe I would want to add like the Vermont Medical Society to get, you know, to ensure that we've get, you know, kind of the overall psychiatric community and doctor communities input into the types of services that that we'd be looking at in here. But I think, you know, victim services, legal aid, etc. All those types of organizations, identifying the gaps. We definitely need to look at competency restoration models and so that's in here. And again, you know, it's fine to take out the specific reference to to Connecticut. But it's as I've, as I've testified today, the need for a facility who would run the facility. What type of structure it would be number of beds. You know, fiscal impact. That just says that it should include but it doesn't limit us. And so I'm not concerned that if there are other areas of appendices, etc. that would be able to include that in the evaluation. Again, making sure that we have enough time to be able to do it is is to me more important than getting it back in a certain timeframe because it's a lift. This is not a small study. This is not a small assessment. And there's a lot of pieces to this. So I think it's incumbent upon us to really do our due diligence and do, you know, do effective research to make the best recommendations for Vermonters to you all. I don't know if I echo what the deputy commissioner said I think when I read this through. Again, it's not really totally corrections is lean right it's it's more mental health lane understanding the forensic piece, but what struck me again I, I don't know about the Connecticut piece and exactly who the player should be around the table, but I do think it's such a large conversation that specific language helps focus the group early on. I spend a lot of time early on, just trying to figure out what what where the white lines are. Right, I think for me when I read through it. My sense of that was okay it's giving very clear directions on, you know, like, like the deputy commissioner said, do we need it what should it look like, who should be involved in how are you going to fund it. I think it's a big step forward I think when we start as we've been saying today about where we're going with that population that we run into every once in a while that just boom it ends. And I think it's a big step and it's an important stuff. One group that I forgot to mention that I think should be a part of this, this working group. If we have, you know attorney general's office, we have defender general states attorneys and sheriffs, but judiciary, I think should be represented, especially, you know, we're trying to talk about who this facility should serve how they'll be served, some of those conditions nice so I think you just share it would be an important partner to include in that. So we're scheduling time with you folks and more folks next week on section six so I don't want to take up too much time today to go into this too deep for this because I want to start closing up on this. So, Sarah, will you finished. Yes, I was and that's very helpful. Thank you. So, Kurt, and I'm going to have to scoot out quickly again just to pay my carpenter. Thank you. I haven't carpentry worked on entry down yesterday. My question that doesn't have to do with I just have a question for the commissioner that's completely different topic but while I while he's here I wanted to ask him but so I can wait until we're done with this. Okay. So any more questions on the forensic section six because we're going to go into a deeper dive with this next week for this but I wanted to give the committee some kind of an overview of what we're dealing with a little bit with this. Anything else for folks. Okay, Kurt. And in the process of preparing for our discussion on probation on probation I went through the lot of the GSC presentations from the Council of State Governments and in there there was mentioned the idea of having the at sentencing to have the judge have do see provide a short report that talks about the person being able to better inform the care that or the programs that that person might need and what conditions of probation there might be. And at the time. Commissioner, I think you said that it sounded like a good idea but you might think about a pilot study or something a pilot of that in just to see how it works out and how much it would really impact the resources of doc. And if that's, if that's still a good idea and it's something that either you've done anything on or something that we should move on. I believe, and I'd have to get back with staff because I haven't been tracking this, but I believe that director Dow crook has been working on a Senate bill that actually that actually does that sets up a pilot. What I'm talking about is, is giving some type of report to the judge before the sentencing is what you're saying. Right, I think there's a pilot project in the works. I'd have to get caught up with director crook to fully understand it. But I did get briefed on that last week and that was moving forward. Okay, good. Thank you. I can be a demonstration site project to see how it goes. And I believe it's moving forward. I'm not mistaken. And if he's back in the committee, I can ask him about it sometime too. So thank you. You're welcome. Dale will be back. You'll be in next week. Karen. Yes, it's funny that representative Taylor brought that up because I had a sticky note. I was looking ahead on our house calendar. And it looks like a Senate amendment is coming on the floor tomorrow that is specifically around this pilot. And it's on age 20, and it's a pilot for pre sentencing report when probation is recommended for a felony to kind of confirm what the ideal probation conditions are. And that is DOC, the courts and states attorney office and defender general together. And I was like, Oh, well, that's an interesting amendment. It seems like it affects our committee so I think things are moving quickly. Well listen representative you're better than I am because you're further up the speed on it but that's, that's exactly where it is it's on age 20. It was an amendment added in the Senate. So that's exactly what's happening now. So hopefully represent Taylor at Elger. I'm going to have to get you a job as the commissioner corrections there. I got you got you covered. So Dale's going to be in our committee tomorrow after the floor to talk on the probation piece and of course this bill. I don't know if he'll be up for action tomorrow or not because it's Senate proposal of amendments we have to give time for judiciary to act on it. We're ready to act on it tomorrow. So we don't know anything else before we finish up here. Okay well thank you Commissioner Baker and Deputy Commissioner Fox and we'll see you more next week when we do a deeper dive on section six. And I'll enjoy the weather folks sunshine and fresh air. Thank you for having us. Thank you. Take care. Have a good evening. Okay. Phew. What a day huh. So I think we're done.