 Hello, everyone. Welcome to the House Health Care Committee afternoon session. Our chair will probably be joining us shortly, but it's tied up in a meeting, so we'll get things started. This afternoon we're starting with further testimony on H210, our health equity bill, and hearing from another of the identified health disparity groups, which is people with disabilities. And I want to start so that I don't forget by referencing two other witnesses and something we haven't done this way before, but that's a protocol. Is when we have an invited witness who has is not able to come but is submitting written testimony. That's a little different from, well, here's our chair. Finish this intro that's a little different from just public comment coming in in writing. And so it's listed on the agenda, and I'm formally referencing it to let you know that that is part of our record of testimony. And that is from Ed Pequen who is the outgoing or recent past executive director of disability rights Vermont. And we also have listed Sarah Launderville who's the executive director of the Vermont Center for Independent Living, who said she was going to try to get written comments in. But they, they have not come in so so that will be removed from the agenda as her having submitted those so that we will now introduce our live witness who. Oh, there she is you, you've. Hello Laurie, I didn't see you for a minute's little hard with zoom. But Laurie Emerson from NAMI Vermont if you could introduce yourself and share your information and perspectives and with that I'm turning it back over to the chair but you can get started. I appreciate you getting things going. So welcome Laurie and thank you. Welcome hearing you all set for me. Yeah, we welcome hearing your thoughts on the health equity bill to 10 which focuses in part on people with disabilities of different kind. Yes. My name is Laurie Emerson I'm the executive director at the National Alliance on Mental Illness of Vermont, also known as NAMI Vermont. And I want to thank you Chairman Lipper and Madam chair by vice chair Donahue for allowing us to testify today. And as well as the members of the House Healthcare Committee. NAMI Vermont supports bill each to 10. And we appreciate this opportunity to provide comments to you as it relates to health disparities with individuals who have a mental health disability. In reference to the bill on page two section one number one, it highlights barriers to good health based on disability. However, it does not include a definition of disability which may be helpful to verify that this includes physical mental and developmental disabilities. Reviewing the list of organizations who are named to be on the council, you know I noticed that NAMI Vermont was not named. And we would like to suggest adding the ability to appoint a family member to represent NAMI Vermont. To have our voice and perspective at the table. Of course I thought I turned off my my phone and my answering machine and I guess I didn't. So that was just one request that you know we didn't see her name there and like to be included. Americans with depression bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without a mental illness. That's a disparity larger than for race, ethnicity, geography or socioeconomic status. America has been growing and receives considerably less academic study or public attention. Americans with serious mental illness live shorter lives than those in many of the world's poorest countries. To study at a large New York medical system, people with schizophrenia are almost three times more likely to die from COVID-19 than those without the psychiatric illness. And the study also showed that people with other mental health conditions such as mood or anxiety disorders were not at an increased risk of death from COVID-19. To stigma and discrimination people with mental illness receive poorer physical care. They commonly report barriers to having their physical care needs met, including not having their symptoms taken seriously when seeking care for non mental health concerns. And I think a good example that I can provide with that is, you know, recently I went to the emerge I went to a doctor's appointment with my, my son. And just prior to that, you know, he was at the emergency room with a mental health crisis. And the diagnosis was right there at the top of the page and we were seeing another medical doctor that he had psychosis. And a lot of times medical doctors may dismiss the physical needs that people might have when they go to visit them. And, you know, we hear about this quite frequently. An American study has found that nearly half of all patients withhold critical information about their mental health out of fear, embarrassment and judgment. The results of the study were derived from two online surveys in 2015 of the 4500 people surveyed 47.5% said they would not disclose information to medical professionals. Over 70% of those surveyed said the reason they would not disclose information about suicidal thoughts or depression was because they were embarrassed fear being judged for lecture. Some individuals will not seek out help or treatment due to their distrust of the medical system in fear of being harmed, involuntarily committed or treated with disrespect. In the emergency room, people who are seen for a mental health crisis are required to strip down in a gown, sometimes in front of a stranger whose job is to watch them. Every person deserves to be treated with respect, dignity and empathy. We would recommend that medical professionals, especially emergency room professionals, receive additional training to better understand trauma informed care that will benefit the care and treatment of someone who may be experiencing a mental health crisis. People with a mental illness or substance use disorder represent 25% of the US adult population, but they consume 40% of all cigarettes sold. Heart disease, cancer and lung disease which can all be caused by smoking are the leading causes of death for people with mental illness. Substance misuse or the repeated misuse of alcohol and or drugs often occur simultaneously in individuals with mental illness and usually to cope with their overwhelming symptoms. And according to the national survey on drug use and health 9.5 million US adults experience both mental illness and a substance use disorder in 2019. Access to treatment and providers continues to be a barrier for individuals with mental illness, and only about four in 10 people in Vermont have with a mental health condition received any treatment in the past year. With depression being the number one leading cause of disability in the world. We need to ensure access to health care is timely. With many wait lists for an in network care, people are turning out are turning to out of network providers, thus costing more money. And despite federal parody laws the promise of parody remains out of reach for people with mental illness orally narrow provider networks and high out of pocket costs are substantial barriers to individuals accessing mental health treatment. And we need to ensure that individuals with mental illness can access the care they desperately need for individuals who receive treatment. Psychiatric medicine can have adverse long term effects that shortens their life and adds more physical issues older generation anti psychotic medicine can affect and damage organs over the long term. Some of the medicine puts people at risk of obesity influencing other medical concerns. Tart of dyskinesia is another side effect of anti psychotic medicines and tart of dyskinesia causes stiff jerky movements of their face or body, and they can't control it. They might blink their eyes stick out their tongue wave their arms but not meaning to do so. So these are just some real serious adverse consequences of medicine that that people take to treat their mental illness. And we must not forget that housing is health care. For someone with a mental health condition the basic necessity of a stable home can be hard to come by. And the lack of safe and affordable housing is one of the most powerful barriers to recovery for people. When this basic need isn't met people cycle in and out of homelessness jails shelters hospitals. Having a safe affordable place to live can provide stability to allow someone to maintain their recovery. One thing that I just wanted to mention you know I've got a phone call recently from some town officials that they had somebody in their town who was living in living in very substandard housing. Has schizophrenia has lived there for about 45 years. There is no plumbing. There is no heat. They don't have any income, but they have these two acres of land that this person is on. It's really hard to get somebody with a mental illness to be able to go to another place to live because of their social isolation, or being around other people may affect them. And this poor gentleman has has been living there 45 years and yet with all the people that have been contacted in the state, there's nothing they can do for him. I kind of find that hard to believe but I'm hoping that with lots of other outreach, there can be something done for this man otherwise they will find him dead in his home one day. That's a tough situation. Nami reminds her from several family members recently that they have exhausted their savings to ensure their family member is getting residential care, and now have no viable options to ensure their loved one has the appropriate care. They need to live in the community. Many family members service caregivers for their loved ones to help them get their needs met. What about the individuals who do not have family. They don't have time for them through paid employment. However, with the shortage of nursing care underfunded mental health community agencies. People's lives are at stake. What about the individuals who don't have transportation or isolated in rural areas. Unable to receive services. What about the policies that need to change to allow medical transportation when it is needed and not on a limited basis because of insurance. During the vision 2030 stakeholder meeting that the Vermont Department of Mental Health hosted. I learned that doctors who have a specialty in physical medicine are paid double if not more than a primary care doctor, which is understandable since you know they have a specialized expertise. However, someone with a specialty in mental health counseling is paid the least of the two. Why do we devalue our mental health as a society and not pay the same as specialists in physical health. In closing, there are many disparities for individuals with a disability of mental health condition. That needs to be addressed. Thank you so much for listening to our comments. Thank you so much. For joining us today. I have to say. It's always important to hear from families. Whose lives have been touched. By this important. Issue disability. And thank you for being an advocate on behalf of families. Absolutely. Did anybody have any questions for me. Open it up to committee questions. You. Yes, thank you. Laurie. It's actually a. A strange coincidence of timing. I know Mary is a representative court is available aware of this as well because we just. We were just working on a resolution honoring John Pandiani. Who lives in Bristol, who lived in Bristol. Who worked for many, many years in the department of mental health. Doing research statistical work on. In fact, some of these very issues. I wonder if you have on hand, if you could share his findings about Vermonters. With mental illness and cancer. So I don't know that I've done enough research on that study. I can take a look. I apologize. I apologize to the chair. I apologize to the committee that there was a setup because that was one of the things I sent to you yesterday. For you, for you to be able to. It was. Not appropriate for me to handle it that way. But I can share it with the committee. I will, I will email it for the record. To committee members. And I could email it as well. And to submit it. And. I did a lot of research on a lot of different studies. And I did not integrate that particular one. We'll receive it. We'll receive it. That's perfectly fine. It's perfectly fine. I think it's striking that one of the things. Laurie, you indicated that. People with serious depression or serious mental illness. They're alive. They're, they're overall. They live. They're much shorter life expectancy. And when we think of health disparities, sometimes we think in terms of. A particular. Type of illness. But we don't think about the broad. Life span. And so I appreciate you bringing that to our attention. It's a striking statistic. It is. It's a striking statistic. And a lot of times it is due to the, the medical physical health needs of the person. You know, they are co-occurring conditions. And sometimes there's multiple conditions. But it does seem to be very common with people with mental illness. And, you know, being able to access and seek that treatment and care is very difficult for people. Because of many factors. And it could be, you know, just. You know, it's hard to even list the number of factors that, that come into play. With why they may have these co-occurring conditions. Thank you. Other questions for representative. Again, it's not really a question. I just on following up with what Lori just said. There are a lot of unknown facts. And I think it would probably surprise people to know that a person with a history of major depression has a substantially higher risk of osteoporosis. These are brain body interactions that. Are just. Unknown to a lot of people from some of these kinds of things. Right. In some cases probably not fully understood. Right. Exactly. Okay. Well, thank you. Thank you so much. Appreciate you doing this on a Friday afternoon. Today is Friday, right, folks? All right. Thank you. Thank you so much. So let me. So with that, I think that. I don't know what to say. I don't know what to say in writing. But that's the, I think that completes our testimony this afternoon. On each two 10.