 Good morning. This is Senate Judiciary and Senate Health and Welfare meeting on F3. We're joined this morning by Katie McKinn and Eric Fitzpatrick from Legislative Council, as well as Morning Fox, the Deputy Commissioner of the Department of Mental Health. And Nolan Linewell, who is the member of Joint Fiscal, if there's any questions about the appropriations that the House added. If you remember, as the bill passed the Senate Committee on Judiciary, there was 500,000 in appropriations. It was an appropriations committee. They took the 500,000 out. I believe Nolan can correct me if I'm wrong, but I believe the additional 30,000 is to the Department of Mental Health to help with the study in the bill. Nolan, do you want to comment on that briefly? For the record, Nolan, I'm with the Joint Fiscal Office. Yeah, it's 25,000 to support the work on forensic care working group, and then 5,000 for prudence. So it's 30,000. Yes, we're going to DME. Anyhow, the Senator, so Senator Lyons and I have looked at the bill along with Eric and Katie and others. Senator Baruth and the Department of Mental Health. We thank the House of Representatives for their hard work on this bill, as well as the improvements to the bill in sections one through five. It is only in section six where we have great concern. Eric could go briefly over the changes in sections one through five if he doesn't mind. Just so you're aware of what, what we would be agreeing to. And I'd be happy to thank you, Senator Sears. Sorry. Senator, I have a question. I'm just wondering, can you put it on the screen, please? Or is that not work with this larger group? Actually, I don't know that that would be helpful. Because. What version are we using 1.1? Yes, the, as far as the documents that you have on your committee page. The probably best one to look at is the one under my name S3 House proposal of amendment. It is version 1.1 though, Senator Nica, although it's, yeah. But as Senator Sears mentioned, the changes to sections one through five are really pretty straightforward. And I can zip through those pretty quickly. The House added, you remember in the Senate bill that the had a lot to do with the examinations that take place when a criminal defendant raises the either the insanity defense or the issue of the defendant's competency to stand trial. And that is raised during, during the proceedings. And the Department of Mental Health was added in on a number of occasions, both to see notice about receive a copy of the initial psychiatric report when it's, when it's ordered by the court, as well as to have party status in that commitment hearing to be able to appear at the hearing and call witnesses. One addition that the House made is to add not only the Department of Health, but the Department of Aging and Independent Living when applicable. And the reason for that, it actually makes sense legally is because there's a separate statute that requires that when the, when the defendant's insanity or competency is that issue because of a developmental disability, as opposed to because of a mental illness, then it's Dale that would be the State Department where the person could be committed if the ultimately they're found to be a danger would be DMH in those particular class of cases they person would go to Dale. So it makes some sense for Dale to be added to the, to the list of folks who would get a copy of the report as well as provide them with party status after hearing if it's developmental disability is the, is the condition that's at issue in the particular case. So that's one of the, and that's done a number of times in those first several sections. Another addition that was made has to do with, you may recall the idea that competency and sanity being two different things. The Senate bill had a provision that required the, the reports, if it was a situation where both competency and sanity are at issue the reports have to be done separately and presented separately to the court. The, the House added a provision based on actually on American Bar Association model language that permits the defendant to request that their reports be done concurrently. So, the general rule would be the reports are done separately but you provide the defendant with the option and defendant might choose to say well I'd rather have the reports done at the same time. The option is added. And another concept that's added to that, that sort of joint report issue is that if the reports are done separately, then there was a concern on the House side about, well you know it could be that, that a report on sanity might be done first or sorry a report on competency might be done first, but you remember that they're that because a person is then is this found incompetent. They could be treated potentially for years they may never regain competency and there may never be a trial they have folks who are for subject to the commitment of dmh right now who were committed a long time ago because I've never gained competency so they added a provision that said okay if, if the reports are done separately, then the psychologist or the psychiatrist to conducts them has to make sort of reasonable efforts to to gather and save any evidence that might later on be used in the in the competency sorry insanity proceeding, if the person regains competency. So some of the main changes in the first couple section, they did not change the section you may recall that permits this the that was requested by the Attorney General's office the request that the prosecution be able to obtain a independent psychiatric report of the defendant in a in a competency case the same way they currently can in a sanity case. And they added some provisions to the evaluation I think Katie, I might ask you for a moment to help on this is a section five. They added some pieces to section five which was the, I think the evaluation, not a study but similar to a study of the dmh and some other players are going to conduct the mental health services that are provided to defendants under the Department of Corrections has, I think they added a few pieces to that. But I think those are the highlights that I can recall at this point. We're not hearing you. No we cannot hear you unfortunately. All right, so I could just add here I pulled up the little summary I did so the little pieces that they added to section five, which is the, the inventory and evaluation of mental health services provided by the entity that doc contracts with the healthcare services. They added some pieces requiring the evaluation to compare the type frequency and timeliness of mental health services how they differ among Vermont correctional settings, an assessment as to how the use of a for profit entity with whom doc contracts for healthcare services affects cost or quality of care and correctional settings that have to assess whether dmh should provide oversight authority for mental health services provided by this entity with whom doc contracts and a requirement that some information be provided as to how the mo you between doc and mental health impacts mental health services provided within doc. There's also some language which you'll see in a couple of places in the bill, requiring that when the evaluation is conducted, that has to ensure that social and racial equity issues are considered, including issues related to transgender and gender nonconforming persons. And I think. I would add that I know this is this is relevant to the forensic care working group and the, remember another major part of this bill was the victim notification piece, this idea that when a, when a someone who's been committed to dmh custody, when their status changes and they are released into the community that that notice is provided to the Attorney General's office and the state's attorney, and that that notice then is passed along to the victim. The Senate bill had a separate notice piece separate from that which also require when a person is already a defendant is already in the community on an OH, an order of non hospitalization. That when that person isn't complying with the order or in some other way the treatment isn't working that notice is provided to the state's attorney and the AG in that situation as well. See so that's a different type of notice different circumstance. The Senate version also had that, because I think there was discussion even at the time as to the how that a provision like that would work so the Senate also had it in the forensic care working. So what the house did was they struck it from the statute so the notice wouldn't be required in that situation, but the working group would still look at it. And there's a separate reporting date on that that I think is perhaps February is that right, Katie. I think that's right so yeah so that would be folded into the report and then they would, the legislature would have an opportunity to look at it again next year. Any questions on those sections that we would be accepted. Any comments from anyone who's here. Deputy Commissioner. The department's okay with these sections. Right. So, why don't we go to where Senator lions myself and others met to try that. The study was quite big and took in more things and competency. We had the house put together. And so we, we sent out as a post concur with further proposal amendment and we wanted to check and make sure it was okay with all of the committees as well as the department of mental health which is going to be involved in a lot of this. I will tell you ahead of time, Senator lions myself, Senator. Deputy Commission morning box and Eric and Katie met to kind of develop this but you are not, you know, if you folks think there should be changes feel free, even though this is on the calendar for this. So do you want to go over, Katie, or do you have voice now. I hope so can you hear me. Oh yeah, this is great. Thank you. Yeah, my first zoom call of the morning sometimes you have audio technical difficulties hit us all. Um, so I have a side by side summary I was thinking I would pull that up and that might be the easiest way to compare the documents. Okay, let me go ahead and do that. Are you seeing a chart. Not yet. You see it. Okay, great. Um, so the column I'm going just to kind of ground you in where we are. This is section six the very last row is the section seven that the house added, but I've broken section six up by different categories to kind of show you how the senate version and the house version are there. So right now I'm going to be walking you through the changes that were made in the house version so that's this middle column right here. So first was the working group. And as you remember section six required dmh to convene a working group the senate version had by August 1 of 2021 and the house version had that the group would be convened by seven. So July 15 2021 and the house version added members to the to the membership of this group you'll see. And in this box this is the list of members that the senate had the house added to that a representative of Dale, the chief superior judge, a representative appointed by the Vermont medical systems. Representative appointed by the Vermont developmental disabilities council. Three crime victim representatives whereas the senate version had to similarly three individuals with lived experience of mental illness versus one in the senate version, and the house added language that at least one of these individuals would have lived experience of the criminal justice or civil commitment systems are both and this, these individuals would be appointed by Vermont psychiatric survivors. And then the house version deletes a representative of bgs. So that is the only member that the house version removed from the working group. So next we move into this. Our proposal amendment would bring back would agree with the house on all the members, but add the back in the bgs we feel if you're going to build a facility, at least be able to hear from bgs. Thank you. And so you'll see this last column here is the, the senate concurrence with further further proposal of amendment that's on this senate calendar today, and you'll have that the senate proposal adds that bgs representative back in. The next row is really the main focus of this working group as it left the senate was examining the overlap in the mental health and criminal justice systems. And there was a report that was due by November 1 of this year, and it was kind of looking at these specific items. And then the house version kind of changed the structure of how this report was to come back. So whereas the senate was asking for a one time report back. The senate version created kind of a tiered process where there were two preliminary reports. And the second preliminary report built on the findings of the first preliminary report, and then there would be a final report that would kind of fine tune the recommendations made in the first two preliminary reports. So, under the house version the first preliminary report is due January 15 of 2022. The final report is due September 15 of 2022. And then I've, and I've highlighted each of the items in this report where the house has added or kind of changed the specific items to be reviewed by this group. So, first were any gaps in the current mental health and criminal justice structure. Next were opportunities to improve public safety and address treatment needs of individuals in the criminal justice system, the house added in consideration for victim rights and forensic care process. Next was competency restoration models in other states that language came from the senate the house added, including models that do not rely on and voluntary medication and how cases or competency is not restored our address. The next item is models used in other states to assess public safety risks, including guilty, but mentally ill verdicts and criminal cases that was not changed by the house. The house did add due process requirements for defendants held without adjudication of a crime processes regarding other mental health conditions, affecting competence or sanity. And then the house listed, well the senate listed models for forensic treatment and the house added to that including inpatient community based or other treatment models. And then the house added any additional recommendations to address the gaps in the systems. Let's back up to kind of point out the differences in the house version and what the senate is proposing. The senate is proposing only one preliminary report versus the two preliminary report structure that is in the house version. The house preliminary report is meant to provide recommendations that the final report builds on the senate version specifies that the preliminary report is for the purpose of kind of giving a status update on the work prior to receiving the final product. So both of the both the house's first preliminary report and the senate's only preliminary report would come in on the same day. There's a difference in the date of the final reports. So whereas the house would be September 15 of 22, the senate version that's on the calendar today would be August 1 of 2022. And the proposal in the calendar today adjusts some of the items that the working group in DMH are going to be looking at. So whereas an earlier version had only any gaps in the current mental health and criminal justice system structure. So the version on the calendar today kind of tightens up that language by saying related to individuals incompetent to stand trial or who are adjudicated not guilty by a reason of insanity. So it narrows the scope of it. The next item opportunities to improve public safety that was accepted the same version as the house is in the senate version on the calendar. The next item is competency restoration models. This language was deleted from this particular report. However, it's not gone all together. Instead, the the request to look at competency restoration models is moved into a separate later in this section that will be due at a different date at a later date. So it's not gone but it is separated and will be addressed separately at a later date. The next item was models used in other states to assess public safety risk that is the same as the house version. Also the same is looking at due process requirements for defendants and processes regarding other mental conditions affecting competence and sanity. Those are the same as the house version. What is not the same is language around models for forensic treatment. This house version. This is part of kind of the tiered decision making. The final preliminary report would have asked that the house proposed would have asked if a forensic treatment model is needed. And then if it was determined that a forensic treatment facility was needed, then that would be addressed in the final report. This proposal in the Senate kind of backs away from that threshold question and instead asked for models for forensic treatment, including the size scope and fiscal impact of a forensic treatment facility. And with regard to any additional recommendations, the Senate version just just limits the language to that phrase any additional recommendations and doesn't have this language about addressing the gaps in the current mental health and criminal justice structures. So those are the changes to that study. I see this is related the forensic treatment facility. This is treated as part of the same report above. As I noted before the house treats us as part of as a threshold question in the second preliminary report. The Senate version on the calendar today removes that second preliminary report and ask for information about the forensic treatment facility right up front. As part of the report that we just went over. I just entered. I've centered alliance and I, and I think mental health agrees. That's the most important thing is as we're making decisions about a new mental health facility. We should also be aware of this forensic issue. And to leave that down the road would make any plan we have for new facility. That's the reason for trying to do this separately. Agreed. Okay. So the next piece, the version that you sent over and Eric already touched upon this was requesting a study on the, the component about the notice to the prosecutor with regard to non compliance, or an adequacy of an order of non hospitalization that was part of the Senate's original proposal and that was coming in on November 1 of 2021. And the house. For the most part kept this language, it just made an adjusted change to reflect the fact that it's no longer required in an earlier section of the bill but this is assessing the necessity of notification to the prosecutor. So I wanted to change the due date to February 1 2022 so they allowed for three extra months for this particular report to come in, and you'll see that the version in the Senate calendar today is the same as the house's version. So next is the competency restoration model piece. And this is the language. I've created a new subsection when I put together the amendment it's a new subsection D. And basically I've taken language from the earlier study and bumped it down to its own standalone section. And this has a later due date so now this analysis by DMH would be due on January 15 of 2023. So the report to the General Assembly comparing competency restoration models and addressing how cases where competency is not restored are handled. Next, the house version added some guiding principles to the work that's being done by this group. The main group is to ensure that social and racial equity issues are considered including issues related to transgender and gender non conforming persons, and also consistency with the General Assembly's policy to work towards a mental health system that does not require coercion or the use of involuntary medication. And the Senate version adopts the same language. There's a technical correction to reflect the fact that there's a new subsection D, but aside from that the language is the same. Next experts the house added language that DMH was to access regional or national expertise to present models to the working group to review including a model. And then by the working group and this language and calendar today is the same as the house version. Similarly draft legislation. The ONH reports the prosecutor notification report, and the final report on mental health and criminal justice system overlap are to be are to include proposed draft legislation. And that language is the same in the Senate version on the calendar today again with a technical change to include the new subsection D. And lastly, section seven. So the house version adds a new section of the bill to adjust the membership of the Joint Legislative Justice Oversight Committee. And they added two members of that committee one member of the House Committee on Human Services and one Senator at large, and the proposal on the calendar today, deletes this section in its entirety, meaning that the current structure of the committee would be would be preserved as it is. I think it's house health care is it Katie. Oh, yes, I'm sorry. Okay, today, say so. Okay, thank you house healthcare yes. I'll pull this down so you can see each other. Comments from anybody. I'm fine. Seems reasonable to me. The department supports this. For the record deputy commissioner morning Fox department of mental health. Yeah, I think in general concept overall we're in support of this. I think that in one of the sections where we're talking about the models for forensic treatment. I know that the most recent amendment took out language around including inpatient community based or other treatment models. And that the language in the in the most recent amendment really kind of goes models for forensic treatment including the size scope and physical impact. And I think even as a part of that. It's not lost on myself or the department that we would be looking at not only that, but part of all of this study is to look at different various treatment models were not the states won't rely just on a facility. You know, is it my position or not that that as I've testified before for a need for a facility. Yes. But that doesn't mean that there's other places that that treatment won't be provided. And so, you know, I think that, you know, for us as a part of all of the study that's going to be a part of this as well. I just I just want to make sure people are clear. I'm not asking for other language necessarily, but I just want to just to put out that, you know, I want people to be aware that we would be looking at, you know, the different types of models and treatment models, because there are are going to be people placed on orders of non hospitalization out in the community and things of that sort. So we do, we do need and we will be looking at other treatment models. So I think, you know, the moving forward with this language is, you know, is is workable for us. Well, it certainly relies on the, the department to do the work that the department understands so without prescribing specific areas for work. So that I think that was the reason that we talked about changing that language. I appreciate that center lines and that's that's really the perspective on coming from as well. So thank you. One of the, it's important to remember the Genesis and bill really was discussions with state attorneys the department of mental health and others and then Senator Clarkson, Senator Wyatt and Senator white myself introduced the bill. And it passed the Senate and died in the house. And we resurrected it as as three I think it's, you know, there's repeating that this is a small group of people but the small group of people has a ability to terrorize certain families in our state and particularly family members and others and also for themselves and the danger to themselves as well. So this is a long time coming. I hope that the house will accept these changes. I don't have any guarantee that they will but I think we owe it to ourselves to make sure that the study is realistic and something that we can move forward with and the other language obviously the community notification and other parts of this bill. I might say the funding too is helpful because I think the department needs that funding and but I also believe legal aid needs that to be able to hire and get expert opinion. If everybody's okay, we won't hold you. I know you have time to get to the floor and put ties on and jackets on for some of us or whatever else. We're on the floor at 10. Dick, can you just stick around when we go off YouTube for a minute? Sure.