Do away with classification ‘boxes’ for severely mentally impaired, lawmakers told

Lawmakers on the SFI summer study committee meet Tuesday. From left, Sen. Jane Kitchell, D-Caledonia; Rep. Sandy Haas, P-Rochester; and Sen. Dick Sears, D-Bennington. Photo by Alicia Freese/VTDigger

Lawmakers on the “Serious Functional Impairments” summer study committee meet Tuesday. From left, Sen. Jane Kitchell, D-Caledonia; Rep. Sandy Haas, P-Rochester; and Sen. Dick Sears, D-Bennington. Photo by Alicia Freese/VTDigger

A group of lawmakers met with lawyers, police officers, service providers and state officials Tuesday as part of an ongoing effort to find a better, less costly way of caring for people who are considered dangerous because of their mental impairments.

The Agency of Human Services stopped funding new individual budgets for these cases in May, citing out-of-control costs. Some of the cases involved 24-hour supervision arrangements, and a few exceeded $300,000 a year.

There are about 220 inmates and two dozen people in the community who are grappling with impairments such as traumatic brain injuries (TBIs) and post-traumatic stress disorder (PTSD) that put them in the category of “serious functional impairments (SFI)” or “complex community cases (CCC).” SFI is a designation used in the correctional system; CCC refers to people with similar profiles who haven’t been incarcerated.

A summer study committee met for the second time Tuesday to look for treatment options and other ways to keep these people — whose needs fall outside the scope of most mental health programs — out of the correctional system.

Several possible fixes were floated — for instance, Robert Appel, the former director of the Human Rights Commission, recommended a stand-alone treatment center at a correctional facility for people still incarcerated. But after four hours of testimony and discussion, the committee didn’t seem to have moved any closer to a comprehensive solution. The group is scheduled to meet two more times.

Toward the end of the meeting, lawmakers repeated a request for more guidance from the Agency of Human Services. “The agency is waiting for us to make a recommendation to you,” Sen. Sally Fox, D-Chittenden, told Monica Hutt, director of policy and planning for the AHS. “But it would really help to hear from the people who are the experts in these fields because it’s very frustrating to make policy based on the cursory ability we have.”

Rep. Sandy Haas, P-Rochester, ask Hutt if the agency had contingency plans for the end of fiscal year 2014, when it expects to terminate the 22 budgets still being funded. “There’s no plan right now,” Hutt told Haas, explaining that the agency is hoping for a legislative solution.

Sen. Dick Sears, D-Bennington, said he’s concerned that civil confinement — court-ordered treatment — will become the administration’s fallback solution.

“Obviously, there’s going to be a big push for civil confinement for some offenders come January, and I have some concerns about that proposal,” he said.

Trish Singer, adult mental health director with the Department of Mental Health (DMH), said the department has discussed that question, but she couldn’t speak to Commissioner Paul Dupre’s position on that policy.

Fox asked AHS officials if the state could solve the problem by expanding its definition of mental illness. “Is there some way we could melt SFI into some other categorical framework that would have enabled us to slip through those Medicaid definitions?”

The discussion meandered, at times, into a more expansive policy territory — such as what improvements to the state’s mental health system would divert people with impairments from the committing crimes in the first place.

Law enforcement officers, who spoke about on-the-street encounters with the severely mentally ill, also called for a “one-stop-shopping” solution.

Burlington Police Chief Michael Schirling said his department has seen a 400 percent increase in the number of calls it receives in which the primary problem stems from a mental impairment.

In 2012, BPD had 499 of these calls and roughly 900 calls where mental impairment was a factor in the incident. “That,” Schirling added, “is only if the officer remembers to check a box.”

Schirling said police officers were the “wrong tool” and the people needed “immediate access to treatment” and “a smorgasbord of placement options,” including structured housing with staff.

The study committee spent the afternoon revisiting the now-dismantled procedures for setting up supervision arrangements for these cases.

“It seems like the big money is in supervision so we’re really interested in seeing how that decision gets made,” said Sen. Jane Kitchell, D-Caledonia.

Haas wanted to know how clients have been faring since the funding moratorium took effect, putting a stop to those intensive supervision arrangements.

“They are in bad shape,” said Margaret Joyal, director of the Center for Counseling and Psychological Services at Washington County Mental Health. “I don’t know what will happen to them when these budgets run out.”

Lynn Boyle, an AHS field service director, gave a less dire prognosis. “There are funding streams [available for people with SFI], but they are for certain things. These people aren’t in one box and it’s a lot harder to do when someone doesn’t fit neatly into one box,” she said.

Box analogies came up frequently during Tuesday’s discussion. Part of the challenge of caring for people with SFI is that they suffer from multiple problems — substance abuse, personality disorders, trauma — but they fall just below the threshold that would qualify them for wraparound services that come with federal funding.

“If we were to redesign the boxes, do you have recommendations?” Haas asked Boyle.

“I think not having boxes is the best answer,” she said.

Alicia Freese

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  • Dave Bellini

    “…what improvements to the state’s mental health system would divert people with impairments from the committing crimes in the first place.”

    THAT, ladies and gentlemen, is an excellent idea.

    • Pat McGarry

      One need not commit a crime to be labelled SFI (the prior statutory term was SMI)- the term is applied to unconvicted pretrial detainees as well as convicts.

  • Will Hunter

    It seems like a constitutional violation that we continue to incarcerate people who have this designation because we can’t figure out how to accommodate them in the community. Perhaps part of the problem is that the plan for supervision is designed by the very people who will make the money from implementing it.

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