 All right, good afternoon, ladies and gentlemen. This is the Vermont State Senate Committee on Institutions. I am Joe Benning, the chair of the committee. Apologies for us having technical difficulties. We were due to be on at 1.30, but we are here live and in person. Including myself, we have Senator Mazza from Grand Isle, Senator McCormick from Windsor County, Senator Ingalls from Essex Orleans and Senator Parent from Franklin County. Laurie Emerson, I understand you're going to start us off in the conversation of mental health during COVID-19. Welcome. Thank you so much, Chairman Benning and members of the Senate Institutions Committee. My name is Laurie Emerson and I'm the executive director at NAMI Vermont. And I wanna thank you for allowing us to provide testimony to your committee today for Mental Health Advocacy Day or week. My comments are gonna focus on two areas. Mental health and COVID in corrections and mental health crisis response and diversion from the criminal justice system. So this year's Mental Health Advocacy Day was held virtually and we brought together over 250 advocates and organizations on February 1st. So if you weren't able to attend, I did provide a link in my testimony and hope that you can take the time to look at the recording and view the day's events. So I collected testimony from somebody that is in corrections or was in corrections and I just wanted to share those thoughts with you. One of the worst experiences anyone can ever have is to be locked up in corrections, especially during COVID-19 pandemic. Imagine what it must be like to enter the correction system and be quarantined for two weeks. This means isolation and solitary confinement when you first arrive. If you leave the correctional facility for core or emergency medical situations, you need to quarantine again for two weeks by yourself in isolation. Once admitted to the mental health unit, you're doing your time in a locked eight by 10 cell with a roommate. Half of the unit is allowed one hour a day to use the common area and staying six feet away from each other where they can at least interact with others. Cloth masks are supplied to the inmates and then washed and reused to whoever gets the mask net. I think we have lost Lori. No exercise time, not able to go outside in the yard, not able to enjoy any hot commissary items such as coffee or other food that needs to be microwaved. Only ready to eat items. No in-person visits from family or friends. On a positive note, what is going well in corrections? There's a signup program called Open Ears that is one-on-one peer support for 45 minutes once a week. It is a wonderful program that helps people connect with someone who understands who is also an inmate. Although there are no in-person visits, there is a rotating schedule of using the phone and inmates are provided with tablets. The new medical care team is a great improvement. Staff are there in-person if needed and people are doing hard time these days in corrections. The second part of my testimony will focus on mental health crisis and diversion from the criminal justice system. When 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 people need. These teams should include peer and family support advocates, but 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 mental health crisis. They can escalate a situation and the likelihood of criminal charges being filed or worse 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 within their community other than calling 911 or bringing their loved one to the emergency room, which should be a last resort and only if someone is in immediate danger to self or others. Last year, federal adoption of 988 as a three-digit number for mental health, substance use and suicidal crises, which will be effective nationwide by July of 2022, provides a path forward to accelerate better options for communities across the country. NAMI Vermont advocates for state and local crisis systems that combine 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 number is active. Vermont needs to ensure the 988 number is comprehensive and addresses mental health, substance use and suicidal crises and not to serve only as a suicide prevention lifeline. We can set up call centers and crisis teams, but what's next? Where do people go to get immediate help? Do we continue to bring 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 followed up on. Another example of crisis response models from Eugene, Oregon, the Kahootz program has been in existence for 31 years. It's a non-police trauma-informed mobile response to children and adults in crisis. And last year, at a total of roughly 24,000 Kahootz calls, police backup was requested only 150 times. As Vermont builds a crisis response systems 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, planning and workforce. Some people respond better to the peer approach. Every community and individual has unique challenges and needs and each response needs to be tailored to fit that local environment and person. Additionally, NAMI Vermont and Team 2 Vermont are scheduling screenings of the Ernie and Joe Crisis Cops documentary that includes an interactive panel discussion with different communities in Vermont. And I would highly encourage a Senate institutions committee to attend the next screening in April. The documentary follows two San Antonio police officers from the mental health unit and how they approach crisis intervention by de-escalation and diverting people from criminal justice systems. So I'll forward that information to you once it becomes available and hope you folks can attend. 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. Thanks so much for listening to our comments. Thank you, Lori. Committee, any questions? Peter and Julie, who would like to go next? Joe, Chair. Yes, Russ, go ahead. One of the things that's always been helpful is if you could ask Ms. Emerson, Executive Director Emerson how she fits into the capital bill or does she? Lori, can you answer that question? So funding for NAMI Vermont? Yes, ma'am. Okay, so our funding for NAMI Vermont includes a grant from the Department of Mental Health. It also includes donations and, no, Peter. Oh, okay. It also includes donations from the community and we're also funded through other grants as well. Okay. So I probably should have given this introduction which I usually do but with the technical difficulties I was a little off base this afternoon. This committee deals primarily with the brick and mortar questions and you're touching on areas that are for the most part policy questions which generally in the Senate are handled by either judiciary or health and welfare but some of your comments are dovetailing with our responsibilities which include what facilities are available to deal with mental health. Keeping that in mind, we have new committee members who are learning who the players are for the first time and we're trying to make sure that everybody who appears before us has some basic understanding presented to the committee about who you are and how you might fit into the capital bill. With that in mind, any other questions for Laurie? Okay, Peter and Julie, I don't know which one of you would like to go first. I'd be glad to go next. Okay. Welcome. And I did prepare some slides and some of that is like who are you and what are designee and specialized service agencies but I can try to go through them quickly and at the end I was gonna talk to you about our capital leads. Does that sound okay? That's perfect. Okay, so I'm gonna try to share my screen. So far I'm disabled, so I need Denise to enable me. There we go. Okay. I'm still disabled. I think that this is just the day for technical difficulties. If you make her a co-host, if you right click on her you can make her a co-host and then she can share. Say when. All right, there we go. Thank you. So my name's Julie Tessler. I work as the Executive Director of Vermont Care Partners, the Vermont Council end of it. Just to tell you what Vermont Care Partners is, it's a statewide organization. We provide leadership to designate and specialize service agencies that provide their nonprofit community member agencies and they serve people with developmental disabilities, people with mental health conditions and people with substance use disorders. This map just kind of shows you the areas that they cover. The designated agencies have somewhat different responsibilities than the specialized service agencies. They have a zero reject responsibility to meet the needs of their communities, whereas the specialized service agencies provide more specialized services and supports. So the core functions is to provide those comprehensive services. We have high needs mandated populations and crisis services to all Vermonters. Each agency has some uniqueness to it depending on its own community and the regional needs. And all the work we do is done in collaboration with healthcare partners, schools, human service providers, employers, housing agencies, shelters, law enforcement, blueprint for health. You name it, we're in our communities. As a system of care, we do maintain core competencies and standards of care and we contribute to the healthcare triple aim. This is just a quick overview. We actually serve 32,000 Vermonters a year as clients, but we touch the lives of more Vermonters because not everyone we serve actually becomes a client, but we do health promotion and outreach disaster response. We do a lot of reaching out to our communities beyond the people we serve as clients. We have 5,000 staff and we also have contracted workers. So people in substance use disorder services total over 3,000, eight of our agencies contract with ADAP. There's nearly 4,000 people who receive developmental disability services. Our crisis services that are 24 seven serve over 8,500 people a year. We serve over 7,000 people in adult mental health services over 11,000 children. And as I mentioned, we have a lot of community outreach education, response disasters, and we use peers for services. Just to be clear that this is not just about people coming in for therapy, all the agencies employ clinicians in primary care settings, although not all primary care doctors have us in them. We're in over 90% of supervisory unions. We provide services in people's homes and in different community settings as well as in our offices. We feel good about our services. We think we're pretty accessible. 67% of the people we serve are able to access, be able to be seen in five days as at least for their initial appointment. And then within two weeks, we serve almost two thirds of them. 90% of people say the services were right for them. 87% say the services made a difference. 84% of the people we serve say their quality of life improved. And 90% say they feel respected. But we had this little thing that happened this year, COVID, right? So 40% of Americans say that they are feeling struggling with mental health and substance use disorders. This is much higher than it was. 11% are considering suicide. 13% have either increased or have started using substances. Anxiety and depression affects almost a third of the population and more than a quarter of people are feeling trauma and stress related disorder. So that's kind of a national picture. If you ask the designated agency directors what they're seeing, they're seeing individuals and families under stress. It's housing, it's food and security, job loss, isolation, loss of loved ones, you name it, you know it, your neighbor is your family, everyone is experiencing it. They're experiencing trauma and the trauma is gonna have lasting effects way beyond when everyone has their vaccines and we're safe to go out without masks again. And it's affecting more people and the people that we have been serving, the purity of their needs is higher. Our staff are also under a lot of pressure. A number of them just said, that's it, this is too hard, I'm retiring, I'm not doing this, this is too much. Some have had to go on family or medical leave because of people in their family whose immune systems are compromised. So the staff that remain have been really stretched then or asking them to do things like use PPE, if they have people in their cars, they have to do all this cleaning and they have to deal with the testing and they're taking risk of serving those at risk and filling for coworkers. This has especially happened in our residential facilities where we've had a number of times where people have developed COVID in our facilities. Now, fortunately, our facilities are small. We had a four-person facility in Bennington where every single person there developed COVID and the staff developed COVID. And at first the staff said, I will just stay, we're already got it, but they're sick and so they couldn't stay. So other staff had to come in. So it's been tough or if we have someone in the crisis bed it was COVID then you can't fill the second crisis bed. So our staff have worked really hard and I wanna thank the legislature for recognition of the healthcare workers out there. What we're finding is we don't have as many staff as we need. We have nearly 500 vacancies out of the 5,000 physicians. We've got a growing weight for outpatient services and urgent care. And we're feeling we don't have enough nursing services, case management and crisis beds. And those crisis beds are not just for adults with mental health crisis but also for elders and people with developmental disabilities that are really feeling that isolation and stress. So that is one of the things we could use capital investment as crisis beds. I do wanna say that we're doing a lot of, we've created warm lines to combat social isolation. We're finding ways to get people food, medicine, educational and activity supplies and we bring them to people's homes. We've distributed tablets, even help people access wifi, which you know is a big issue. We have had to temporarily house some people in hotels who are in crisis because as I mentioned, we don't have enough crisis beds and sometimes a two bed unit only serve one person, especially if someone has COVID or has been exposed. We are doing more outreach to individuals and families, especially those who have been in hotels and motels. We are, I think you've read in Dettger that the conditions there are not great. We've been doing lots of virtual telehealth and support services by Zoom and the audio only and I'll go back to that in a minute. We've also been doing a lot of public education. Hopefully you've seen some of the COVID support for month that Vermont Care Partners has been working on with the departmental health to help people have coping skills, to have outreach to crisis counseling and supports and education and ideas about how to maintain wellness and we're doing more wellness activities, not just for the people we serve, but also for our staff and communities. So we've really mobilized to address COVID. Before COVID, literally we had provided only 28 telehealth services to 24 Vermonters between last November and February. So when COVID hit, you can see we just really increased that service. It's been really critical to us being able to provide supports to people in their homes. 80% said the services were helpful, 60% said it's actually as good as in person and it really varies. For some people it's not as good and for some people they prefer it. One thing we have less of is no shows. So what kind of support do we need from the legislature? We need investment in services. And I know this is not what you do but you are as senators, you're always involved in everything. We need investment in our workforce with all those vacancies it is a big issue and we've been having struggles because we have not been getting great increases on a regular basis like state employees and we don't have the cost shift capability of health providers. So we've really been close to level funded for quite some time and our salaries are really low. So when we find someone to hire, very often they turn us down because we can't offer them significant salaries. We also need to develop more educational opportunities for our workforce and increase some very specific services to elders, the homeless, to improve outreach and serving people in the criminal justice system and we do support the justice reinvestment initiatives. But we do have one-time investments and we realize that that is where there's more resources this year. We could use one-time investments and things like the work with the hotels, the case management, helping people before they get on SSI, doing trainings, investing in the stabilization programs especially when we can't have them at full census because of COVID and addressing some of the one-time expenses like the air systems, equipment facilities and testing. So specifically our finance directors when we reviewed what their needs are in capital and we need new facilities. We need facilities to house people. We're actually one of the major houses of low income people in the state of Vermont. Their people are homeless elders in particular because many times they don't necessarily need nursing home care and they get stuck in the hospital because there's nowhere for them to go. Most nursing homes aren't well equipped to serve people with elders with psychiatric needs but we could develop specialized programs so we'd actually need to have the residences, the crisis beds and office space because of COVID right now is more challenging. We need to be spaced out more. We have a great need for renovation and upgrades. There's a lot of safety risks out there. ADA, the hand to cap accessibility is, we're not all there the way we should be. HIPAA compliance means that we actually need to have soundproofing between where we serve clients and we don't always have that. We need better air filtration systems and for accessibility, we need the elevators and chair lifts or using a lot of old buildings that don't have that. And because we've been under resource for so long we really need investments in maintenance and repair. Roofs, windows, doors, flooring, carpeting, ramps, boilers, kitchens, you name it, we need it. So we have significant capital needs and I know that you've been focusing on state programs. Woodside we support, the secure residential we support but we are a big part of the mental health service system and the more that we can support people in the community the fewer people would need inpatient and the higher level residential care. So we think it's worth the investment. I know it's an unusual ask but I hope that you would consider it and we certainly could give you more detail if you are interested in doing that. And I can see if I can figure out how to stop screen sharing. Did I do that? I don't know. I still have it on your screen. Stop share. Okay. There we go. So Julie, the capital bill begins in the house as you know, I don't know if you've approached the house. I don't know if you actually had anything in the governor's recommend but the upshot is the conversation if you're asking for money would be starting in the house and then we would see what happens when they send it over to us in March. We'll keep your thoughts in mind. We can't obviously make any promises but your challenge is to talk to the house first to see if you can't squeak in under the tent so to speak to try to get something from the capital bill. Thank you. Committee, any questions? Seeing no hands. Peter, welcome. Yeah. Thank you, Senator. And thank you all for having us here today and I'm Peter Mallory and I'm vice president in charge of government relations and community outreach and advocacy for the Ramon Association of Mental Health and Addiction Recovery, otherwise known as VAMHAR. And I really am here mostly to back up Laurie and Julie. I know you're pressed for time. I don't have any immediate capital requests. So I think Julie covered that well and I support those and we'll do what I can to help her in the house. Otherwise, it's been a really good week for mental health and mental health awareness. And I feel that the three of us have done this now for what Julie, six or seven years and I think it's working better and better. As Laurie said, we had 250 people on Monday and that is a tribute to virtual success, if you will. I may be back to you and I'll talk to Denise if that's all right because week after next we're gonna do work on recovery issues and there might be some capital ideas there that I'll take up with the representative Emmons but might be interested in having 10 minutes at some point on that. And I've had Tracy Hawke in from Rutland on her program a couple of years in a row and you've been very gracious to hear her but maybe I'll try to squeeze her into judiciary this year. So you have a little more time for other things. So that's really all I've got. I think Julie and Laurie have covered the bases real well. We appreciate this opportunity. Sure, I appreciate you guys coming in. Our committee is made up of three new members, one who's a brand new legislator and in this new world of YouTube presence there are probably people out there in the public. I don't know how you check and see if anybody out there is actually watching but should they be, the basic introductions are really important for people to know all about you. In the event that the capital bill comes over to us and at that point in time there is a monetary request we would probably have you back in. So that's after crossover but that's the point where you'd probably be making a play for money if that happens to be planted in there first by the house. So now's a great time to be talking to Alice and moving forward from there. Okay. So thank you very much for coming this afternoon. We hope you all have a great day. Thank you. Great to see you all. Take care. Thank you. Bye bye. Catherine, just to give you a heads up and committee you as well.