2021-11-22 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
2021-11-22 00:00:00 - Joint Committee on Mental Health, Substance Use and Recovery
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mm. All right, good afternoon everyone. Welcome to the Joint Committee on Mental health substitution recovery. Thank you for participating in today's hearing. My name is Adrian Madrazo. Uh I'm the state representative for East boston24 and proud to serve as the House chair of this joint committee, joined today by my Senate co chair and good friend Senator Julian sear um Senator, would you like to say a few words? Good afternoon. Not always a pleasure working with you chair Madaro And you know, I think we've had some really productive hearings ranging a whole host of issues. Um some of them real common sense, other of them trickier today, sort of our hearing where we're We're going to hear some late filed bills today. Uh and some other bills we didn't get to, but I think we've got a lot of work ahead of us between now and joint rule 10 day, but it's really grateful for your leadership and and the real thoughtful participation um of members uh certainly are House members. Um and yes, even the Senate members. I've noticed my colleagues really, the Senate has really been chime in on this committee, which is uh I think indicative the interest that that senators have in this issue. And certainly I think our shared commitment to do um to do some good work here. So turning it back to you, thanks thank you senator. Uh and like my co chair said today, it's basically a catch all hearing for some late filed bills are going to be hearing testimony on three bills related to mental health for which we did not hold a hearing in the spring before we get going into testimony. I'd like to recognize some house members of the committee who joined us today. Representatives dan Kari Traa, Nguyen and uh I believe that's it for the house members right now and we'll recognize others122 as they come and I think we'll just get right into testimony. At this point. I do see my colleague Representative Liz Miranda has joined us.
[REP MADARO:] Uh Representative, I believe you are testifying on your bill H4164 an act expanding access to trauma informed care and mental health first aid. Please take it away.
[REP MIRANDA:] [HB4164] Good afternoon to all my colleagues and I am really excited to be here today. I'm here. Mr chairman um both sierra Madaro members of the committee to talk about piece of legislation. I filed 4164 an act expanding access to trauma informed care and mental health first aid training. I just want to lead by saying before I go into my remarks, um I really come to this piece of legislation as a survivor of homicide um as a former youth worker, as someone who's in the community that I serve. The philosophic district of Roxbury and Dorchester, which is the most of color district in the entire commonwealth and understanding that we've actually gone through pandemics within pandemics. Right?
So covid 19 then housing pandemic than199 economic lack of opportunity pandemic among that a racial reckoning in this country we haven't seen and you can look at the news every day and see that we're incredibly stressed as a nation and the commonwealth is not immune um too many of what is happening to people across the country. So this bill would include establishing a centre that will serve as a source for evidence based mental health and trauma first aid training for residents of the commonwealth to educate everyday individuals on how to support others who may be suffering232 from a mental health condition or trauma. It would reduce biases against mental illness and allow residents, other states are more comfortably engaged with issues relative to the trauma responses they need and their overall mental well being. It would also expand access to mental health first aid training and knowledge, which will allow us to reach those on the ground who are most likely to be near predictable conflict when someone is experiencing a crisis and underserved communities.
We do not always have access to a clinician or trauma response professional, but expanding access to mental health First Aid will ensure that anyone who would like to271 become skilled in de escalation and how to respond when someone is in crisis actually has the ability to do something. We hope that this was center and allow Ciena's retail workers, crossing guard, faith leaders, youth workers and more to bring mental health expertise closer and to the center of292 our communities. Some private companies themselves have started to provide mental health first aid training as they recognize their workers are closest to predictable conflict in times of crisis and need to be empowered with the knowledge, skills and forces they need to respond. Let me give you some examples. Over 34%, 1 in three seniors in Roxbury have diagnosed clinical depression. More than 7% are diagnosed with schizophrenia or another psychiatric condition. More than 12% have experienced substance abuse and the combination of a mental illness all higher than the state average.
In North Dorchester In North Dorchester, 66 16.6% of our 60-plus population experienced more poor mental health More than 15 days a month. That is more than double the state average. In a survey conducted by the public health community here in Boston, between 15 and 17% of residents of Roxbury and Dorchester reported feeling persistence Sadness, despair and poor mental health status and nearly 30 reported feelings of high anxiety and now this isn't just because of the pandemic within pandemics and the racial reckoning. Many of our communities have been facing these issues for a very long time without access to affordable and culturally competent care. Even B. M. C. S. Ambulatory psychiatric team has reported 131% increase in patient volume since august Just today. My colleague John Santiago told me the story of a young 15 year old boy who attempted suicide from Roxbury and Dorchester and just two weeks ago we had two400 men returning back from incarceration who were involved in police shootings that are no longer here.
The trauma grief and loss are district has experienced Through the COVID-19 pandemic. And up until today has created a fierce urgency for us to expand access to mental health first aid and trauma response. And it can't just be on clinicians and master level professionals and social workers. We need to empower all of our residents to become versed in mental health and trauma response if they want to. Mental health crisis has been prevalent in nearly every age group in our community and it's only been worsened by everything that we've gone through the last two years and we're seeing this play out every day on the news when a preventable preventable tragedy occurs. Thank you to both of you and the members of the committee. And I would urge and respectfully ask for a timely favorable report on this critical legislation. I think that can help us address on mental health needs, particularly underserved and under resourced communities like mine
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,one big thank you representative, do we have any questions from committee members?
[SEN CYR:] I would just say I've I've participated in a mental health first aid training before actually, I think it was through NCSL. Um but you know, certain certainly482 found that experience valuable. I think it's uh it's very interesting stuff. So thanks for finding the bill.
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Uh thank you in that they can to take mental health. You know,
if you have the mental health first aid, it's uh you can take it readily available and you can take it and it might give you some interesting perspective.
[MIRANDA:] So to share to more things. One of the things that when I came to the state house after losing my brother less than a year before, um I came with this idea that I was going to help solve gun violence. And as I began to travel across the country and talk to people providers and organizations, I realized that the core of preventing gun violence is not necessarily all about gun reform, but527 the idea that our communities were suffering from poverty and a lack of opportunity and no access to the mental health and trauma services that they needed. So these, these mostly these young people when you talk to them and visiting them in Carcel facilities, we'll talk about the trauma that they faced throughout their whole lives that had never been addressed. And and so I looked at an initiative out of new york city called NYC thrive and it helped me write the bill because it made it accessible affordable to get the training, the eight hour training.
But it was also multi lingual and multi cultural and so in new york city, they provided training in every borough, in every neighborhood of every borough in spanish and Arabic and chinese and mandarins are um and other languages and particularly for a city like boston that speaks over 100 languages. I thought it would be incredibly important to provide this resource free of charge in available on the ground, uh, to help us combat the other social issues that were faced with not just gun violence, but we talk about suicide593 is on the rise, particularly around black and brown Children and immigrant communities. I thought this would be a great resource600 to help our current infrastructure as it's growing to be able to provide that. SHOW NON-ESSENTIAL DIALOGUE
Yeah, thank you, rep. Do we have any questions from the committee members? Uh, rep win,
[REP NGUYEN:] thank you616 so much. Uh, thank you Representative Miranda. This is really very interesting concept and I appreciate your leadership on this. Can you talk more about how you envisioned the partnership with community organizations, especially in, you know, spreading information about this new concept, but I love the idea of making it language accessible and making sure that we are being intentional about outreach to black and brown and immigrant communities. Mhm.
[MIRANDA:] What's incredibly important is that as we look to file the legislation and get it passed is that we have to work with the Department of Mental Health and Health and Human Services for the commonwealth to655 be able to design and basically make a place holder, whether that's a center, whether that's a lead staffer, whether that's a team to really look at how we could play out in massachusetts. This example came from one city in the large state of new york. And so I think we have some nuances in the commonwealth. We've already pumped millions and millions of dollars into our mental health infrastructure. I think what's critically important, particularly in the season that681 we're in is that we don't go back to normal, normal wasn't good enough. And so particularly around ensuring that we're reaching harder to reach communities, uh language barriers that we already have in dealing with those communities and then be able to provide the culturally competent care that I think is missing from some of our current providing sources.
I think this will be a long process, but hopefully in working with the departments that we already have and the organizations already doing this, maybe we can do the set asides. I really want to be able to create the type of pool of money and a717 piece of our department of mental health. That actually creates the resources so that as cities and towns look at if this model would work for them that they are able to tap into the state to be able to use best practices to start the program. Just f. Y. I the program in new york city after running for three years, um Just just737 to reset, um to be able to figure out how they could use the data and the metrics that they learn from the program and I think that will be incredibly valuable to us in massachusetts as well as we don't do something wrong right? If we can learn from another city or another state on how to provide that and include some of our already our work that we're doing. I757 think that's how it could be done.758 SHOW NON-ESSENTIAL DIALOGUE
Thank you.
Any other questions from committee members? Mr Chair police.
[CYR:] I would just encourage, I'm Representative Miranda to take a look at um something we do the mental health abc act. It was actually one point out we didn't in february 2020. Um actually, it's it's in the newer version we just passed and that's creating an office of behavioral health promotion uh and prevention and is along the same idea of having one entity and state government who is responsible for doing behavioral health, especially mental health provoked promotion and prevention work similar to what you're talking about. So, so take a look at that there. I think it definitely I'm hearing from a number of colleagues. We're hearing it today and we heard it in the Senate when we pull this together, is that we're doing we are uh funneling an unprecedented amount of resources to address the mental health crisis that we817 see in our communities and our families, but we need to make sure that we are, you know, almost pulling in the same direction. And so I appreciate your comments about wanting to have an entity and state government. You know, whether it's a. D. M. A. Two super posed the mental health abc act has it at the EOHHS s. I know the department some of this work to um but figuring out a home for this, I think it's something that you've touched on and I I couldn't agree more. I think we've got to figure that out. So thank you for uh raising that issue, it's an issue. SHOW NON-ESSENTIAL DIALOGUE
Thank you so much. I also want to just quickly recognize that Representative Higgins has joined another House number of the committee and uh I neglected to mention at the outset, I just want to be clear uh you know this hearing is being recorded and streamed live and archived copy will be made available in Legislature's website. Um due to the remote nature of this hearing, those wishing to provide oral testimony were required to sign up in advance. So if there's anyone on the call who was not able to sign up in advance, we encourage you to submit written testimony to the committee at any time. You can email that two committee staff listed in the hearing description or just simply send it to890 chair Sear or myself. Um and uh the reason why you know we have, we just heard from Miranda is because we do have a policy of taking legislators out of turn. So all of those testifying. Thank you for your patience and uh we will be limiting testimony to Three minutes per person first.
[MADARO:] We will be hearing testimony on as 1010 and Act establishing a psychiatric advance directives for mental health care.
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I believe Susan handle from the mental health legal advisors committee and Sarah Ahern from the recover project and connect are on uh you're on now if you're available please before yours
if I may Representative Madaro I'm Phil castle from mental health legal advisors committee. I believe that Susan Fondle is still at this morning's meeting. If you could perhaps put her off to somewhat later on a letter know that you've called her by text. Sure I will let you know we have a pretty961 short agenda today so we'll move on. But if she could join sooner rather than later that will ensure that she'll be able to orally testifying. If the hearing concludes, she could certainly send in written testimony. Thank you. Uh is shower eager in here.
Mhm. Um Okay, um Circling Back to Representatives. Representative Miranda is Bill H. 41 60 for is Sarah Davidow from the Wildflower Alliance available.
Yes, I'm here. The floor is yours.
[SERA DAVIDOW (WILDFLOWER ALLIANCE):] [HB4164] Great thank you so much998 to the committee and everyone who's999 made the1000 space available. So I'm the director of Wildflower lines home to afia Appiah respite recently recognised1005 by the world Health Organization as one of about two dozen exemplary rights based approaches, supporting people in crisis. Much of what I will say here echoes what I said last week to the United Nations human rights Commission. Well, I can appreciate the intent of H 4164 to broaden access to education. This legislation refers expressly to mental health care State, a very specific training. I'm not only attended this training but published an article on the many problems with it. If the intent is to help reduce stigma, this is not the way this is a deeply flawed training that claims to be evidence based in spite of the fact that most of its evidence is simply that people who take the training leave more familiar with the material image.
Much of its material, not only disrespects those of us who have those experiences, but is very limited in its1047 cultural awareness beyond being available in other languages and does little more than promote the same ineffective responses that have brought us to this point in time with people getting trapped1056 in systems they1057 can't get out of and suicide rates on the rise. In May, the latest of many articles was published telling us that anti stigma, efforts that focus on mental1065 health literacy, better understanding of what gets called mental illness, fails to reduce stigma. We can't continue to ignore this research as an internationally recognized trainer on related topics. I beg of you to set aside anything that would further fund mental health First Aid or anything close to it and instead support people such as my coworkers and others across the state who have lived those experiences and are far better equipped to bring something different because the last thing we need is more of the same on H 3962.
I'll be frank evidence has been mounting that hospitalization as a response to suicidal thoughts and so many other struggles ultimately pushes people to want to die even more. In february 2020. New research said that even the perception of coercion at the point of admission increases risk of suicide upon discharge. This speaks to the profound impact that loss of power in one's life can have on their own. Well being. Research also tells us that if someone plays an active role in their own healing and regaining the power that they tend that they tend to move through experiences of trauma and emotional1124 distress much more effectively. There is no doubt that avoiding hospitalization in favor of environments that support someone's retain their agency1131 is the1132 right direction. And there's also no doubt that prompt access to an attorney and due process and the courts is essential as is minimizing the week for those processes as much as possible.
Think of any time in your alliance when you were in a bad situation and left to indefinitely wonder what was happening next. I'm asking to really try and put yourself1149 back in that situation and remember how1151 it felt in your mind and body and how it impacted your emotional state. We need to stop doing that to people in emergency rooms and help them not land in ers at all if possible. The harsh realities that our hospitals are great at dealing with true medical emergencies like heart attacks and overdoses whether intentional or not. But they are failing. Those of us who sometimes find ourselves facing life disrupting emotional distress. Those outcomes haven't improved in several decades. You have the power to do something different here and it is well beyond time for that change. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you for your testimony. Do we have any questions from committee members?
Mr Chairman?
[CYR:] I would just encourage members um to but when I when I said you know take mental health first aid I would be curious for committee members feedback after taking it. Um I I found part of a very useful, I can also understand some of the critiques that we're hearing um as1209 well. So I think feedback on that would be would be helpful from members that if they experience it. I found that I've under instructive from a policy perspective in instructive instructive in helping me kind of figure out where I live on the policy.1227 So thank you Mr Chairman and thank you for the testimony.
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Thank you my allowed to respond to better
if you would like to add something.
[DAVIDOW:] I just I just want to add this is this is the training that was1239 created by two white1240 people in Australia and like I think there's always something you can get out of a training but I think it's extremely limited and as someone who has a psychiatric1248 history, I would say the information is giving people is often inaccurate and harmful. So I just really want to underscore that, but I can appreciate that. Yes, it can be informative in terms of getting1257 a sense of the issues and where people are falling.
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Thank you Mr Abbado. Next week, we will hear from Audrey Herman.
[AUDREY HERRMANN:] [HB4164] Hi, my name is Audrey Herman. I'm a Masters of public policy student and I am testifying in support of House Bill 41 64. Um This piece of legislation would create a1279 Center for Mental Health First Aid within the Department of Mental Health. The center would focus on evidence based mental health and trauma first aid training programs for the members of the commonwealth and to help educate others on how to support people with mental health issues, trauma et cetera while friends and family can be great support systems, it's important for them to have proper training on how1296 best to help their family and friends. Those who participate in the training program would feel more confident in their ability to help those they care about and would also help decrease the stigma surrounding mental health issues. Um this legislation is extremely important and timely.
The COVID-19 pandemic has exacerbated crisis is with mental illness addiction and trauma therapists are booked out for months in advance and it is difficult to find someone taking on new clients. Additionally, there are many barriers therapy. Many insurances do not fully cover the cost of therapy session. I myself had this experience recently where my insurance Did not want to cover the 1st $2,000 of therapy sessions. So I was not able to attend. I am lucky to have great friends and family to lean on but if a program like this existed it would help them support me more effectively. Additionally, I would like to be involved in this program to help my own family and friends through their own mental health addiction and trauma struggles.1351 These are some of the most important social emotional wellbeing problems that plague our country and it's important to act now. Um I hope this bill will1359 be reported upon favorably and thank you for your time and consideration. SHOW NON-ESSENTIAL DIALOGUE
Thank you so much for your testimony. Do we have any questions from committee members? Yeah,
okay, hearing none.
[MADARO:] We'll move on to H 3962 act relative to ending unnecessary hospitalizations and reducing emergency department boarding.
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First up1383 we have Karen Owen tally from CPCS mental health litigation division and on deck as1390 rick Glassman,
[KAREN TALLEY (CPCS):] [HB3962] good afternoon chairs and members of the committee. Karen tally with mental health litigation division of CPCS here to testify in favor of House 396 to The late Chief Justice Ralph Gantz referred to people detained in emergency rooms under section 12 a as being held in a no man's land. That was an oral argument in January of 2020 in the case of Massachusetts, General Hospital vs cr That's the case in which the SJC became aware that people with mental health needs were regularly being held against their will in emergency rooms for days or weeks at a time with no time limit, no treatment, no right to counsel1432 and no right to a hearing. A client access to share with you how being trapped in this no man's land made her feel and Howitt negatively impacted her mental health. This young woman is a trauma survivor and over the last 10 months have spent multiple ers in central mass, sometimes boarding for 4 to 7 days at a time.
Here's what she asked us to share with you being locked up in the er without any treatment made my symptoms worse not better. Sometimes No one would interact with me for hours. I felt alone and ignored, like no one wanted to help me was usually told to stay in a Donny in a curtain off1474 room, I had very little privacy and no ability to move around or get fresh air. I would get increasingly frustrated and angry after days of being in this situation but rather than offer me support or help me calm down, I was physically restrained by staff and forcibly medicated as a trauma survivor. I can't begin to describe how triggering and upsetting these situations were, It felt like a vicious cycle that repeated itself every time I was brought to the er this committee is aware this is a very complex problem involving not only legal rights but timely access to behavioral health care where and when it's needed.
And it was partly because of that complexity that when the SJC decided mass general versus Cr in april of 2020 if they exist body an opportunity to address the problem. It stated, we strongly encourage the Legislature to identify a 12 day time deadline to clarify the statute and avoid future constitutional difficulties to do so as expeditiously as possible. So we know that in April1536 of 20 and 20 this legislature's time and attention are understandably focused on the COVID-19 pandemic. However, we now also know that the pandemic only exacerbated people's mental health needs increased er boarding times. Historically revealed just how broken our current1552 system is. House 3962 is the right bill at the right time. It's the right bill because it takes a comprehensive approach.
As we've heard other people describe. It will reduce the numbers of people who are involuntarily detained under 12 day by providing timely community-based care consistent with the road map for behavioral health reform. Mhm. It will also And establish a widely accessible database showing open beds in real time and ensure that stays and emergency departments are time limited with legal protections available after 12 hours. It will also require data collection and reporting to the legislature. It's the right time for this bill because it also coincides with an unprecedented state national focus. I'm gonna need to transform behavioral health care. So with that I see that my time is up. We hope you'll answer the SJC's call and prevent people with mental health needs from being winding up in this no man's land. That's when they need our help and compassion the most.
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Thank you for your testimony. Do we have any questions from committee members?
Okay, hearing none. Before we move on to Mr Glassman, I do just want to recognize House Vice Chair Michele Dubois has joined the hearing. Mr Glass on the floor is yours.
[RICK GLASSMAN (DISABILITY LAW CENTER):] [HB3961] Thank you. Chairs members of the committee. My name is Rick Glassman.1640 I'm the director of advocacy at the disability law center. As you might know where the protection and advocacy system designated under federal law for the commonwealth. That means we provide a range of services to people who have mental health issues in their lives. We monitor our facilities, we engage with policymakers and so on. We're here today to strongly support House 39 62. As you've heard this would address the crisis of emergency room boarding, which is ineffective, inefficient, costly and most important? Re traumatizing as you heard from Sarah David all the way in which these systems exercise coercion and don't because they simply cannot respect the autonomy of the individual at least people in so much worse of shape as they were before they enter the system.
So what we see commonly is reports from people who have entered crowded emergency rooms, were there for days on end, in states of acute distress, there in a waiting room or a hallway for hours and hours or longer. And they're1700 interacting with people who don't have strong training in working with people who are in crisis. They may have difficult or even abusive interactions with hospital security officers and they are subjected to the same chaotic, highly stressful environment of an emergency room. But at a time when they are even less able to manage that leaving everything often worse than when it started. Um And the second other point that I wanted to make is that we have in the background Now a crisis dealing with emergency rooms generally it's a perfect storm because of differ preventative care in the delta virus among unvaccinated people on staff shortages and so on and so in any of the emergency rooms.
Now there are people stacked up like cordwood waiting 10 12 hours sometimes. And um what happens when you introduce people who are in um in states of distress into this chaotic environment? Well right now we have between 550 and 757, people every two weeks who are turning in and out of emergency rooms, 30% of mental health-related emergency visits result in boarding and as you've heard already, I can't put it more eloquently than Sarah Davidow did or or the story by by by by Karen tally is that there's another way to do this. We can do this in less restrictive community based crisis and stabilization programs, programs like wildflowers, peer run respite the living room by advocates. We are already doing this. Were able to do it in a decentralised way without turning people into Emergency rooms and in psychiatric hospitals. So we encourage you to support this critically important legislation. House 39 62. Thank you very much.
Thank you. Mr Glassman. Any questions from committee members? SHOW NON-ESSENTIAL DIALOGUE
Okay, seeing none. Next up, we'll have Stephen Schwartz from the Center for Public Representation uh and Philips castle from the mental health legal advisors committee will be next. Mhm.
[STEVEN SCHWARTZ (CENTER FOR PUBLIC REPRESENTATION):] [HB3962] Thank you very much. Chairman. My name is steven Schwartz on the legal director of the Center for Public Representation. The center is a statewide and national public interest law firm and Technical assistance center that provides support to people with disabilities and public interest and private lawyers who represent them. Therefore, primary reasons why we believe the Legislature should Support and enact house Bill 3962 first, it's legally necessary to conform Chapter 1 23 Section 12 A to the1869 constitutional statutory requirements that govern the laws of our commonwealth. The SJC, as Miss Tally has said already has held that Chapter 123 and the emergency detention provisions of 12 a must include a consideration of less restrictive alternatives. This concept, less restrictive alternatives is the most basic federal constant and state constitutional requirement that applies to all rules that restrict our liberty.
In fact, the legislature has already enacted the concept of less restrictive alternatives in section four of Chapter 123 and the Department of Mental Health has incorporated in its regulations. The federal government in enacting the americans with disabilities act, has mandated that state agencies must provide behavioral health emergency services in the most integrated settings. So amending section 12 a to require consideration and of exhaustion of these. Less restrictive alternatives is necessary just to confirm conform this section two constitutional and statutory requirements. Second consideration of these alternatives is programmatically and cost effective and by requiring services community service to be exhausted before people are involuntarily involuntarily transported to a hospital is both the right thing to do and the most cost effective thing to do.
The federal government massachusetts. State agencies and professional associations all agree that community behavioral health services like crisis intervention and emergency services are more clinically effective, Moore programmatically effective and more cost effective than psychiatric hospitals and certainly than emergency rooms. So ensuring that these alternatives be exhausted before someone is involuntarily transported to a hospital is consistent with what behavioral health agencies and1991 professionals believe is the most appropriate behavioral health care. Third, it's more compassionate and effective to provide emergency mental health services in a community setting than attempt to do it and failed to do it in a hospital emergency room.
And so perhaps more importantly than any other of the four reasons responding to psychiatric emergencies in caring community settings where people, which the people with disabilities prefer is likely to be more effective, more long term and ultimately, what is the right thing to do by the citizens of our commonwealth who have disabilities? And fourth, and finally, as I close, it is more pragmatic for the legislature to determine the best way to modify this statute than to leave it to the SJC to set a deadline that doesn't necessarily consider what other alternatives are available. Thank you so much. MR Chairman and thank you for the opportunity to testify.
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Thank you. Mr Schwartz. Do we have any questions from committee members?
Okay, next up, we will hear from Philips castle, from the mental health legal advisors committee, followed by Ghana Marsh at the massachusetts Association for Mental Health.
[PHILLIP KASSEL (MHLAC):] [HB3962] Good afternoon. I guess anyone doesn't know about MHLAC where state agency under the judiciary were hitting on our close to 50 year birthday. We do legal and policy advocacy for poor people with real or perceived mental health problems statewide. I'm going2086 to focus on one point alternatives aside from their impact on the DDS and the impact of substantial aside from that alternatives to hospitalization are good, both for people in crisis and for society at large if fully employed. I believe they would address the needs of most people who now are brought to Edie s uh avoiding trauma as well as you've heard and improving outcomes. The research shows it's effective alternatives that2116 is and they reduce the need for hospitalization both in the short and long term and of course they're less expensive. There's a famous model that governs help doctors operate do no2127 harm. But as you've heard force placements are inherently harmful.
Uh And and2134 sadly too many cases the results are exacerbating that there are are exacerbating uh things that happened in the DDS that result in uh extraordinary trauma. I spoke to a client recently. There's a big guy he was threatening apparently to people in the D and he was in his view uh without cause2158 beaten and restrained and forcibly medicated. His promising career was derailed is yet to recover from the experience. And you know people research shows that there are alternatives. As in said previously there are effective. I've heard people talk and I'm going to focus just on pure respite right now. Pure2177 support is one of the things that the alternative step the statute would require E. G. Staff to explore. I've heard people talk about coming out of crisis in these environments which employ people who have been in the same place who offer a sympathetic year in a comfortable environment.
Much different from E. Ds The sterile isolating E. D. Uh environment. Um H. 39 62 would require the alternative be at least explored. And I'll say this instruction is necessary. It's not typical that this happened. We've spoken to clients who have begged DP staff to consult with their own therapists and been rebuffed the tactic of increasing hospital beds that's manifest in the AARP statute. Frankly, I believe it's wrong headed. We need we need a new2228 paradigm. The solution the E. D. Boarding crisis is to reduce the need for hospital beds not to continue this method of dealing with psychological psychological crisis that actually creates the demand for them. H 39 62 is a good step in the right2245 direction and the next2246 step would be to make alternatives more available. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you very much for your testimony. Do we have any questions from committee members?
Okay. Next. We will hear from Donahue Rausch from the massachusetts Association for Mental Health. Who will be followed by ruthie Pool from Beko Human Services.
[DANNA MAUCH (MAMH):] [HB3962] Thank you. Chair Cyr Chair. Madaro And members of the committee.2277 I appear today in support of House 39 62 as a former state Mental Health Authority Director. Special needs health plan, Executive program research as scientists and co chair for the last few years of the Middlesex County Restoration Center Commission. I've been privileged to visit study implement and evaluate robust crisis services that include service alternative to edie boarding and unnecessary hospitalization. You've heard about what the bill does and the importance of its amendments. I just want to note that the regional crisis care centers envisioned here could be access 24 7. They could2314 connect people immediately with services in their area and meet people where they are with a wide array of services that depend on their needs, including peer supports, outreach and follow up As one option provided as an alternative to et boarding program.
Clinical staff would conduct an evaluation and initiate treatment alternatives such as 1-1 observation in crisis intervention, urgent care and have family involvement and peer support as I said before. So we'll be using services that currently exist in some part of or will be enhanced and cemented through implementation of the roadmap. There really couldn't be a better time to do this and to build on the work we have now with psychiatric emergency services teams, mobile crisis intervention urgent care, which is now coming to be crisis stabilization units, intensive outpatient programs, partial hospital programs and residential support services. I just want to underscore again, all of this exists in part now and would be provided a strong boost by this bill and several EDS, notably Children's hospital and U. Mass Medical Center are already employing models to send people home from EDS with wrap around supports rather than having them wait and the living room programs in Western massachusetts and Central massachusetts are doing similar things as alternatives2401 to edie boarding. This does improve systems of care for people in crisis in significant ways as people have recounted testifying before me.
The ability to make new community connections and use your current community structures is far preferable than to be stuck in an E. G. Another important option is really that we don't want to divert important resources that need to be used by those in a life threatening crisis. We need to reserve the limited intensive services and needs for those2432 who really need them. And this would provide an opportunity for people to be served elsewhere. So I just want to say one or two more things um for the reasons that I have talked about, particularly that we are poised at this point in time to implement a number of these things and you have before you in this session, a number of bills including uh funding for implementation of some of the services we're talking about. I respectfully request that you report House 39 62 favorably out of committee and if mh mh can provide any additional information, please don't hesitate to call on2472 us. Thank you so much for your consideration and ongoing leadership on behalf of people for at risk or living with mental health and substance use2481 conditions. SHOW NON-ESSENTIAL DIALOGUE
Thank you so much for your testimony. Do we have any questions from committee members? I
want to emphasize that House any member Representative sally Kerans has joined. Thank you sally uh
whatever I just want to remind folks to please mute. If you're not speaking, please mute. Your computer's. Uh Next2509 we will hear from ruthie pool from Beko Human services will be followed by celeste clerk from the Wildfire flower Alliance.
You're muted.
[RUTHIE POOLE:] [HB3962] Yeah sorry about that. You would think after almost two years that I wouldn't do that but I told him I was sorry about that Good afternoon and thank you for the opportunity to testify today in support of house Bill 3962 my name is ruth the pool and I'm the Assistant Director of recovery big hope human services in2552 boston. I'm a certified peer specialist and I've been working in pure support for over 30 years. Emergency room2559 boarding is a huge problem. It's rather mind boggling2562 to think that 779 people were boarded in emergency departments in October alone. Some may think that this is caused by the pandemic. The pandemic may have exacerbated the problem but er boarding has been a significant problem for many years. Some years ago I was that one of the recovery learning2582 communities run by people with lived experience of mental health diagnosis, trauma and addictions. I was conducting a workshop on mental health rights.
People were interested in learning about their rights when being held under section 12 I then heard story after story after story about being held in various emergency rooms without access to regular meals, the outdoors or any communication from our staff about what was going on. One man told me about being held for 18 days in the emergency room under section 12. When he tried to leave, security guards would stop him. No one suggested that he called a lawyer and no one offered any legal or other resources personally. I've been transported to the emergency room by ambulance and held against my will and emergency rooms under section 12. 2 different times in my life. These were some of the most horrible experience is I've ever had in life. I was alone and scared both times.
The police have been involved which added to my level of fear. Emergency room staff took my cell phone and I had no way of contacting family or friends for support at Melrose Wakefield Hospital. I was given a shot of held all even though I was not making any noise or2661 causing any problems. I refused the medication but they did not respect my wishes and gave me the shot anyways, I was told that it was standard procedure to give any everyone who came2672 into the er under section 12 this serious antipsychotic medication even if they refused or it was not warranted in. Anyways I was alone there for over 12 hours and then I was admitted to the psych unit upstairs. No one explained what was going on or2688 offered me the chance to seek legal advice. H 3962 would go a long way to address the problem of er boarding.
The bill requires that alternatives be explored before taking someone to the are I'm hopeful that the state2703 will fund additional crisis alternatives such as Peyron respite such as Sophia in Western Mass And the living room in Framingham and in Springfield which offers supportive healing environment run by people like me who have been there ourselves. We have very few of these beds in Massachusetts. The people of the bill also establishes the right to an attorney within 12 hours And the right to a court hearing within 48 hours. These are positive measures that will go a long way to address the current inhumane situation. Thank you very much for this opportunity to testify. Thank SHOW NON-ESSENTIAL DIALOGUE
you so much for your testimony. We have questions from committee members.
Okay, seeing none. Next we will have celeste clerk from the Wildflower Alliance.
[CELESTE CLERK (WILDFLOWER ALLIANCE):] [HB3962] Hello. Oh yeah Hello. My name is soliciting Marisa work and I am here to provide my testimony in support of Bill H3962 an act relative to ending unnecessary hospitalizations and reducing emergency department boarding. I am one of two co directors for the Wildflower alliances,2780 Wild ivy Social Justice Network, a program which seeks to involve the voices of our most marginalized communities in policy and practice. Making discussions such as these. Thank you for your time. My testimony in support of this bill is focused on bringing to light all too common professional and material consequences of boarding and committing people under distress. I will focus on the issue of being held for unspecified amounts of time that there is much to be said about the way we respond to suffering in this culture. In July of 2019 I was held for psychiatric evaluation for a period of three days.
During that time I had recently completed my studies at Smith College. As a returning student, I was doing well. I had highest honors from my department, several coveted research positions and I was working at a law firm as part of my ongoing preparation for law school when I reached out for help that july a stranger at a crisis centre after less than an hour decided that I could commit myself voluntarily or she would commit me despite communicating that I could not lose this job to this. Not when I had no financial means, I came from none or had any support system, no savings sufficient to cover my rent. She had me sent to the er anyway at the er I communicated the same thing over and over again to a revolving door of totally burnt out staff. I asked for a timeline for evaluation and release or commitment so I could figure out a way to notify my job and protect my housing but I got no answer and I got no interest at the facility was the same though the social worker evaluating me considered it a good sign that I was worried about losing my job.
He praised the worry a lot. I lost my job though I notified my supervisor that I had a medical emergency. I could not tell them when I'd be back. And three days is all it took for both the stigma of suspecting exactly what happened to me and my inability to tell them when I would be back is all that. It took three days. I urge you to support the passing a bill H396 to however you may feel about approaches to moments of crisis and I do have my thoughts. I would hope that you can see that answering a moment of distress in a whole life with risking and2925 gambling, someone's income, someone's professional reputation, someone's housing. And the basic ability to even feed oneself is not the answer.2934 Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you for your testimony. Do we have any questions from committee members?
Okay, seeing none. Thank you2950 so much. And I do want to recognize another house committee member has joined us. Representative paul Tucker Good to see you. Uh is Mona Seagram from the center2961 for public representation here. I know that she was tentative so I'm not sure if she was able to join today. Um
This is Mr said Mr Schwartz uh because she was working with me. We don't need another person to testify from this and and appreciate your opportunity. Thank you. Oh uh now we have a few folks who signed up through laws but did not identify which bill they are testifying um you know for or against. So I will call these folks in the order that they signed up, robert maloney,
robert maloney
about Stephen Fox, chair of the south end forum,3014
Stephen Fox.
Oh
okay, john Donovan transformation project coordinator at the wildflower allowance alliance. SHOW NON-ESSENTIAL DIALOGUE
Hey rick madam, I am here please. The floor is yours.
[SEAN DONOVAN (WILDFLOWER ALLIANCE):] [HB3962] Thank you. Um yeah, thank you. Thank you coach Ayers Thank you committee. Thank you Everybody who showed up today for this hearing. Yeah, I'm currently working with the Wildflower Alliance where um, Celestine Cyr also working uh I will say in a number of weeks I will be changing a position to start working for the city of North Hampton. Um so I'll be doing something different but related to help develop a new department of community care which is based in non police, non clinical responses to human distress and conflict. And so I'm sharing that because I think some of what I'm taking this position is what I'm testifying on today, I'm here to speak in favour of House Bill 3962. Um and I don't want to repeat so much of what some amazing friends and colleagues have said.
Um but what I will say is that I think it's an amazing opportunity to cut down on some of the trauma loss of resources and quite frankly, just a mismatch of supports that happened in the emergency department where people on staff there are not prepared to support folks for numbers of days and where you know, the people that I have supported, who have been in those positions when I was an advocate felt like they were in a solitary confinement situation which just led to more conflict and distress. So testifying in favor of3117 House 39 62 I will also just add um just to build on some of what Sarah David House said about H 4164 about expanding access to trauma informed care and mental health First Aid that I really wanted to first of all say thank you to Miranda for putting out the words around her community and what are what are needed in Roxbury and otherwise other places in our, in3139 our state.
Um and I really do want the committee as as a co chair, Cyr said to really think about what is what is mental health first aid, what is mental health in some ways to and so when mental health care state advertises itself, it says that it teaches you how to identify, understand and respond to science of mental illnesses and substance use disorders in your community. Now, for me, as someone who is an advocate and I was suffered as well in the world. I'd rather that people not try to respond to, you know, imagine symptoms, but really connect with the distress that I might be in the conflict that I'm in. And so what I, what I do worry about is just to build on what Sarah had said. So eloquently that is mental health first aid really the tool that's going to get us there truly respond to distress in the community. What are the roots of what's going on with someone when they want to die? Um, a lot of that is related to a powerlessness, not having resources, not feeling heard. And so, um, mental health first data. I really just worry if it's just going to feed right back into the problem of emergency room boarding.
Like if we just start to locate these experiences as mental health conditions, are we not therefore going to seek out these services that are already over taxed. And so I really want to call on the committee and the legislature quite frankly to put money one possible into alternatives like3217 pure respite community led responses. The black response is doing3221 great work in Cambridge massachusetts for that. There's places groups like estoy3225 aqui that are working on latino based in Latinos based responses to suicide prevention. There's a wildfire alliance just has already been named a few times. Um, and then there's just a lot that we could be putting money into that might actually get at the real issues at the root of this distress. I think sometimes when we say the phrases mental health, mental illness, I'm not sure if we're all talking about the same thing, but more importantly, I really hope that our legislator can look at you know what's at the root of these things and maybe put some more efforts and resources into responding to the roots of these distresses and conflicts and injustices rather than just keeping it on the status quo. So thank you so much for hearing me and for your time.
3267 SHOW NON-ESSENTIAL DIALOGUE
Thank you for your testimony. Do we have any questions from committee members?
Okay, thank you so much. Mr Donovan. Um I'd like to just acknowledge that3281 Representative Allyson, Sullivan a member of our committee has joined us. Thank you rep. And uh is thomas Brown president of mass PRC available to testify,
thomas Brown.
Okay, let me circle back up to see if Susan handle from mental health legal advisors committee is here.
[SUSAN FENDELL (MHLAC):] [SB923] Yes. Okay, thank you for circling back. Um I have two bills that I was hoping to testify on. Uh one is the bill that uh Shaun Donovan was just talking about uh we urged3333 the sponsors of the bill and the committee to amend the provisions of that bill prior to a proceeding further uh sponsors probably had the best of intentions in proposing a center to educate the public about how to support people in distress and reduce stigma. NHL I see does not believe that the bill as worded will be the best vehicle to do so, emotional cpr comes closer to achieving the goals of the bill. Emotional cpR differs from mental health care stayed in significant ways, rather than treating persons facing emotional or psychiatric challenges as others.
Um emotional cpR teaches people that emotional crises are universal experiences and our inherent to the human experience. Russi e CpR persons learn how to form supportive connections to create a sense of safety for persons in distress by concentrating on what the person is saying. Rather than on how to label the person, we each develop unique means to protect ourselves when dealing with emotional crises and trauma. Sometimes those protections show themselves in unusual behavior, emotional cpr training develops listening skills that are useful to people in distress rehab, regardless of how that distress is exhibited.
Also, in contrast to mental health care stayed, emotional cpR focuses on the goals of the individual and the individual's designation of what would be helpful at the time of crisis for recovery. Mental health First Aid focuses on identifying resources which are typically standard mental health services. Sometimes what a person in crisis needs has nothing to do with typical mental health services. It may have to do with housing or the inability to get resources to support their families. Uh food instability. All right. In addition, any training or in any curriculum to reduce stigma needs to have advocates with lived experience of psychiatric challenges and mental health treatment as part of the authors or builders of that stigma training education and in terms of setting up on the specifics of any training to help people support others in distress. Thank you very much for your time on that bill.
SHOW NON-ESSENTIAL DIALOGUE
Should I go on to
psychiatric advanced directors? Yes. If you could just be brief, very brief. Um Let me just grab that. Oh sorry.
Okay. Yeah. Mh LSE strongly supports psychiatric advance Directives because their means to respect the choices and the wishes of people with psychiatric diagnoses. Currently the treatment preferences persons with mental health challenges are not respected even when they are in writing uh and they were written when they were when the individual was confident, paternalism and stigma with which persons labeled with mental illness is demeaning to people with psychiatric diagnoses and detrimental to all stakeholders. Providing an enforceable means for persons with psychiatric diagnoses to participate in a meaningful way3594 and how they are treated when deemed by others unable to do so.
3599 It's an important step in fixing a multitude of problems in current approaches to treatment of persons with emotional psychiatric challenges. S- 93 makes the psychiatric advance directive binding, which is a critical piece of this legislation given the stigma and implicit bias towards persons with psychiatric diagnoses. That evidence is itself in the belief that once a person is labeled with a mental illness. All their decisions are questionable or attributable to psychiatric issues. This particular provision is vital. S923 lists items that are psychiatric advance directive can include these items are the subject of many calls. two MHLAC. For example facilities. Mhm. Clients report that certain facilities give substantive cares care treat their patients disrespectfully. It is not going to help with the persons recovery if they are placed in3678 that same facility.
Medication clients have reported that medication they don't believe side effects and in efficacy reports uh type of treatment. The people3691 with the psychiatric diagnoses are the experts and what will work and uh other other preferences like don't come in my face when I'm agitated. Leave me alone. Let me go someplace else and sell down for somebody else. It might be don't put me in a room by myself. That freaks me out. Um That can be in the advanced psychiatric director. So I hope you will support this bill and reported out favorably. Thank you very much so much for your testimony. Do we have questions from committee members on either of the bills she testified on? SHOW NON-ESSENTIAL DIALOGUE
Thank you. Okay um and lastly I wanted to circle back to Sarah ahern shower you available
Sarah Hearn?
Okay well that concludes the testimony for this hearing. If there are folks who wish to testify but did not have a chance to sign up again. Please feel free to submit and to submit written testimony to the committee will be sure to a review that I do want to thank L. I. S.3773 For helping us facilitate this virtual meeting and the committee staff for their diligent work in putting this hearing together together. Thank you to all those who testified today for your time and perspective on these pieces of legislation. And I wish you and your families a wonderful thanksgiving. Thank you so much and stay well happy thanksgiving. Take care of Hi everyone.
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