Mental Health System of Care

V.S.A. tit. 18, ch. 174

in effect

18 V.S.A. § 7251 Principles for mental health care reform

7251. Principles for mental health care reform The General Assembly adopts the following principles as a framework for reforming the mental health care system in Vermont: (1) The State of Vermont shall meet the needs of individuals with a mental condition or psychiatric disability, including the needs of individuals in the custody of the Commissioner of Corrections, and the State’s mental health system shall reflect excellence, best practices, and the highest standards of care. (2) Long-term planning shall look beyond the foreseeable future and present needs of the mental health community. Programs shall be designed to be responsive to changes over time in levels and types of needs, service delivery practices, and sources of funding. (3) Vermont’s mental health system shall provide a coordinated continuum of care by the Departments of Mental Health and of Corrections, designated hospitals, designated agencies, and community and peer partners to ensure that individuals with a mental condition or psychiatric disability receive care in the most integrated and least restrictive settings available. Individuals’ treatment choices shall be honored to the extent possible. (4) The mental health system shall be integrated into the overall health care system and ensure equal access to appropriate mental health care in a manner equivalent to other aspects of health care as part of an integrated, holistic system of care. (5) Vermont’s mental health system shall be geographically and financially accessible. Resources shall be distributed based on demographics and geography to increase the likelihood of treatment as close to the patient’s home as possible. All ranges of services shall be available to individuals who need them, regardless of individuals’ ability to pay. (6) The State’s mental health system shall ensure that the legal rights of individuals with a mental condition or psychiatric disability are protected. (7) Oversight and accountability shall be built into all aspects of the mental health system. (8) Vermont’s mental health system shall be adequately funded and financially sustainable to the same degree as other health services. (9) Individuals with a psychiatric disability or mental condition who are in the custody or temporary custody of the Commissioner of Mental Health and who receive treatment in an acute inpatient hospital unit, an intensive residential recovery facility, or a secure residential recovery facility shall be afforded rights and protections that reflect evidence-based best practices aimed at reducing the use of emergency involuntary procedures. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.), § 101; 2015, No. 21, § 2, eff. May 13, 2015; 2017, No. 200 (Adj. Sess.), § 13.

18 V.S.A. § 7252 Definitions

7252. Definitions As used in this chapter: (1) “Adult outpatient services” means flexible services responsive to individuals’ preferences, needs, and values that are necessary to stabilize, restore, or improve the level of social functioning and well-being of individuals with a mental condition, including individual and group treatment, medication management, psychosocial rehabilitation, and case management services. (2) “Designated agency” means a designated community mental health and developmental disability agency as described in subsection 8907(a) of this title. (3) “Designated area” means the counties, cities, or towns identified by the Department of Mental Health that are served by a designated agency. (4) “Enhanced programming” means targeted, structured, and specific intensive mental health treatment and psychosocial rehabilitation services for individuals in individualized or group settings. (5) “Intensive residential recovery facility” means a licensed program under contract with the Department of Mental Health that provides a safe, therapeutic, recovery-oriented residential environment to care for individuals with one or more mental conditions or psychiatric disabilities who need intensive clinical interventions to facilitate recovery in anticipation of returning to the community. This facility shall be for individuals not in need of acute inpatient care and for whom the facility is the least restrictive and most integrated setting. (6) “Mobile support team” means professional and peer support providers who are able to respond to an individual where he or she is located during a crisis situation. (7) “Noncategorical case management” means service planning and support activities provided for adults by a qualified mental health provider, regardless of program eligibility criteria or insurance limitations. (8) “No refusal system” means a system of hospitals and intensive residential recovery facilities under contract with the Department of Mental Health that provides high-intensity services, in which the facilities shall admit any individual for care if the individual meets the eligibility criteria established by the Commissioner in contract. (9) “Participating hospital” means a hospital under contract with the Department of Mental Health to participate in the no refusal system. (10), (11) [Repealed.] (12) “Psychosocial rehabilitation” means a range of social, educational, occupational, behavioral, and cognitive interventions for increasing the role performance and enhancing the recovery of individuals with a serious mental condition or psychiatric disability, including services that foster long-term recovery and self-sufficiency. (13) “Recovery-oriented” means a system or services that emphasize the process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. (14) “Serious bodily injury” means the same as in section 1912 of this title. (15) “Warm line” means a nonemergency telephone response line operated by trained peers for the purpose of active listening and assistance with problem-solving for persons in need of such support. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.), § 101; 2013, No. 192 (Adj. Sess.), § 1a.

18 V.S.A. § 7253 Clinical resource management and oversight

7253. Clinical resource management and oversight The Commissioner of Mental Health, in consultation with health care providers as defined in section 9432 of this title, including designated hospitals, designated agencies, individuals with mental conditions or psychiatric disabilities, and other stakeholders, shall design and implement a clinical resource management system that ensures the highest quality of care and facilitates long-term, sustained recovery for individuals in the custody of the Commissioner. (1) For the purpose of coordinating the movement of individuals across the continuum of care to the most appropriate services, the clinical resource management system shall: (A) Ensure that all individuals in the care and custody of the Commissioner receive the highest quality and least restrictive care necessary. (B) Develop a process for receiving direct input from persons receiving services on treatment opportunities and the location of services. (C) Use State-employed clinical resource management coordinators to work collaboratively with community partners, including designated agencies, hospitals, individuals with mental conditions or psychiatric disabilities, and peer groups, to ensure access to services for individuals in need. Clinical resource management coordinators or their designees shall be available 24 hours a day, seven days a week to assist emergency service clinicians in the field to access necessary services. (D) Use an electronic, web-based bed board to track in real time the availability of bed resources across the continuum of care. (E) Use specific level-of-care descriptions, including admission, continuing stay, and discharge criteria, and a mechanism for ongoing assessment of service needs at all levels of care. (F) Specify protocols for medical clearance, bed location, transportation, information sharing, census management, and discharge or transition planning. (G) Coordinate transportation resources so that individuals may access the least restrictive mode of transport consistent with safety needs. (H) Ensure that to the extent patients’ protected health information pertaining to any identifiable person that is otherwise confidential by State or federal law is used within the clinical resource management system, the health information exchange privacy standards and protocols as described in subsection 9351(e) of this title shall be followed. (I) Review the options for the use of ambulance transport, with security as needed, as the least restrictive mode of transport consistent with safety needs required pursuant to section 7511 of this title. (J) Ensure that individuals under the custody of the Commissioner being served in a designated hospital, an intensive residential recovery facility, a psychiatric residential treatment facility for youth, and a secure residential recovery facility shall have access to a mental health patient representative. The patient representative shall advocate for persons receiving services and shall also foster communication between persons receiving services and health care providers. The Department of Mental Health shall contract with an independent, peer-run organization to staff the full-time equivalent of a representative of persons receiving services. (2) For the purpose of maintaining the integrity and effectiveness of the clinical resource management system, the Department of Mental Health shall: (A) require a designated team of clinical staff to review the treatment received and clinical progress made by individuals within the Commissioner’s custody; (B) coordinate care across the mental and physical health care systems as well as ensure coordination within the Agency of Human Services, particularly the Department of Corrections, the Department of Health’s Division of Substance Use Programs, and the Department of Disabilities, Aging, and Independent Living; (C) coordinate service delivery with Vermont’s Blueprint for Health and health care reform initiatives, including the health information exchange as defined in section 9352 of this title and the Health Benefit Exchange as defined in 33 V.S.A. § 1803; (D) use quality measures, manageable data requirements, and quality improvement processes to monitor, evaluate, and continually improve the results for individuals and the performance of the clinical resource management system; (E) actively engage stakeholders and providers in oversight processes; and (F) provide mechanisms for dispute resolution. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.), § 101; 2015, No. 11, § 18; 2021, No. 115 (Adj. Sess.), § 4, eff. July 1, 2022; 2023, No. 137 (Adj. Sess.), § 4, eff. July 1, 2024.

18 V.S.A. § 7254 Integration of the treatment for mental health, substance abuse, and physical health

7254. Integration of the treatment for mental health, substance abuse, and physical health (a) The Director of Health Care Reform and the Commissioners of Mental Health, of Health, and of Vermont Health Access and the Green Mountain Care Board or designees shall ensure that the redesign of the mental health delivery system established in this chapter is an integral component of the health care reform efforts coordinated pursuant to 3 V.S.A. § 3027. Specifically, the Director, Commissioners, and Board shall confer on planning efforts necessary to ensure that the following initiatives are coordinated and advanced: (1) any health information technology projects; (2) the integration of health insurance benefits in the Vermont Health Benefit Exchange to the extent feasible under federal law; (3) the integration of coverage under Green Mountain Care; (4) the Blueprint for Health; (5) the reformation of payment systems for health services to the extent allowable under federal law or under federal waivers; and (6) other initiatives as necessary. (b) The Department of Financial Regulation shall ensure that private payers are educated about their obligation to reimburse providers for less restrictive and less expensive alternatives to hospitalization. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2017, No. 85, § F.8, eff. June 28, 2017.

18 V.S.A. § 7255 System of care

7255. System of care The Commissioner of Mental Health shall coordinate a geographically diverse system and continuum of mental health care throughout the State that shall include at least the following: (1) comprehensive and coordinated community services, including prevention, to serve children, families, and adults at all stages of mental condition or psychiatric disability; (2) peer services, which may include: (A) a warm line; (B) peer-provided transportation services; (C) peer-supported crisis services; and (D) peer-supported hospital diversion services; (3) alternative treatment options for individuals seeking to avoid or reduce reliance on medications; (4) recovery-oriented housing programs; (5) intensive residential recovery facilities; (6) appropriate and adequate psychiatric inpatient capacity for voluntary patients; (7) appropriate and adequate psychiatric inpatient capacity for involuntary inpatient treatment services, including persons receiving treatment through court order from a civil or criminal court; (8) a secure residential recovery facility; and (9) a psychiatric residential treatment facility for youth. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.), § 101; 2023, No. 137 (Adj. Sess.), § 5, eff. July 1, 2024.

18 V.S.A. § 7256 Reporting requirements

7256. Reporting requirements Notwithstanding 2 V.S.A. § 20(d), the Department of Mental Health shall report annually on or before January 15 to the Senate Committee on Health and Welfare and the House Committee on Health Care regarding the extent to which individuals with a mental health condition or psychiatric disability receive care in the most integrated and least restrictive setting available. The Department shall consider measures from a variety of sources, including the Joint Commission, the National Quality Forum, the Centers for Medicare and Medicaid Services, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration. The report shall address: (1) use of services across the continuum of mental health services; (2) adequacy of the capacity at each level of care across the continuum of mental health services; (3) individual experience of care and satisfaction; (4) individual recovery in terms of clinical, social, and legal results; (5) performance of the State’s mental health system of care as compared to nationally recognized standards of excellence; (6) ways in which patient autonomy and self-determination are maximized within the context of involuntary treatment and medication; (7) the number of petitions for involuntary medication filed by the State pursuant to section 7624 of this title and the outcome in each case; (8) barriers to discharge from mental health inpatient and secure residential levels of care, including recommendations on how to address those barriers; (9) performance measures that demonstrate results and other data on individuals for whom petitions for involuntary medication are filed; and (10) progress on alternative treatment options across the system of care for individuals seeking to avoid or reduce reliance on medications, including supported withdrawal from medications. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.), § 101; 2013, No. 192 (Adj. Sess.), § 2; 2015, No. 11, § 19; 2023, No. 137 (Adj. Sess.), § 6, eff. July 1, 2024.

18 V.S.A. § 7257 Reportable adverse events

7257. Reportable adverse events (a) An acute inpatient hospital, an intensive residential recovery facility, a designated agency, a psychiatric residential treatment facility for youth, a forensic facility, or a secure residential recovery facility shall report to the Department of Mental Health instances of death or serious bodily injury to individuals with a mental condition or psychiatric disability in the custody or temporary custody of the Commissioner. (b) An acute inpatient hospital shall report to the Department of Mental Health any staff injuries caused by a person in the custody or temporary custody of the Commissioner that are reported to both the Department of Labor and to the hospital’s workers’ compensation carrier. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.), § 101; 2013, No. 192 (Adj. Sess.), § 3; 2023, No. 137 (Adj. Sess.), § 7, eff. July 1, 2024; 2025, No. 147 (Adj. Sess.), § 6, eff. July 1, 2026.

18 V.S.A. § 7257a Mental Health Crisis Response Commission

7257a. Mental Health Crisis Response Commission (a) There is created the Mental Health Crisis Response Commission within the Office of the Attorney General for the following purposes: (1) to conduct reviews of law enforcement interactions with persons acting in a manner that created reason to believe a mental health crisis was occurring and resulted in a fatality or serious bodily injury to any party to the interaction; (2) to identify where increased or alternative supports or strategic investments within law enforcement, designated agencies, or other community service systems could improve outcomes; (3) to educate the public, service providers, and policymakers about strategies for intervention in and prevention of mental health crises; (4) to recommend policies, practices, and services that will encourage collaboration and increase successful interventions between law enforcement and persons acting in a manner that created reason to believe a mental health crisis was occurring; (5) to recommend training strategies for public safety, emergency, or other crisis response personnel that will increase successful interventions; and (6) to make recommendations based on the review of cases before the Commission. (b)(1) Each incident involving an interaction between law enforcement and a person acting in a manner that created reason to believe a mental health crisis was occurring that results in a death or serious bodily injury to any party shall be referred to the Office of the Attorney General by the relevant law enforcement agency for review, analysis, and recommendations within 60 days after the incident. Interactions not resulting in death or serious bodily injury may be referred for optional review to the Commission, including review of interactions with positive outcomes that could serve to provide guidance on effective strategies. A law enforcement officer or mental health crisis responder involved in such an interaction is encouraged to refer it to the Commission. (2) The review process shall not commence until any criminal prosecution arising out of the incident is concluded or the Attorney General and State’s Attorney provide written notice to the Commission that no criminal charges shall be filed. (c)(1) The Commission shall comprise the following members: (A) the Attorney General or designee from a division other than that investigating the interaction; (B) the Commissioner of Mental Health or designee; (C) a member of the Vermont State Police, appointed by the Commissioner of Public Safety; (D) a representative of frontline local law enforcement, appointed by the Vermont Association of Chiefs of Police; (E) the Executive Director of the Vermont Criminal Justice Council or designee; (F) a representative of the designated agencies, appointed by Vermont Care Partners; (G) the director of Disability Rights Vermont or designee; (H) an individual who has a personal experience of living with a mental condition or psychiatric disability, appointed by Vermont Psychiatric Survivors; (I) a family member of an individual who experienced or is experiencing a mental condition or psychiatric disability, appointed by the Vermont chapter of the National Alliance on Mental Illness; and (J) two regionally diverse at-large members, appointed by the Governor, who are not representative of subdivisions (A)-(G) of this subdivision (c)(1), such as an emergency dispatcher, specialist in interactions between law enforcement and individuals with a perceived mental condition, or a representative of the Vermont Human Rights Commission or Vermont Legal Aid. (2) The members of the Commission specified in subdivision (1) of this subsection shall serve two-year terms. Any vacancy on the Commission shall be filled in the same manner as the original appointment. The replacement member shall serve for the remainder of the unexpired term. (3) Members who are part of an organization involved in an interaction under review shall recuse themselves from that review and shall not access any information related to it. The Commission may appoint an interim replacement member to fill the category represented by the recused member for review of that interaction. (d)(1) The Attorney General or designee shall call the first meeting of the Commission to occur on or before September 30, 2017. (2) The Commission shall select a chair and vice chair from among its members at the first meeting and annually thereafter. (3) The Commission shall meet at such times as may reasonably be necessary to carry out its duties, but at least once in each calendar quarter. (e) In any case under review by the Commission, upon written request of the Commission, a person who possesses information or records that are necessary and relevant to review an interaction shall, as soon as practicable, provide the Commission with the information and records. The Commission may subpoena information or records necessary and relevant to the review of an interaction from any person who does not provide information or records in his or her possession to the Commission upon receiving an initial written request. A person who provides information or records upon request of the Commission is not criminally or civilly liable for providing information or records in compliance with this section. (f) The proceedings and records of the Commission are confidential and are not subject to subpoena, discovery, or introduction into evidence in a civil or criminal action. The Commission shall not use the information, records, or data for purposes other than those designated by subsections (a) and (i) of this section. (g) To the extent permitted under federal law, the Commission may enter into agreements with nonprofit organizations and private agencies to obtain otherwise confidential information. (h) Commission meetings are confidential and shall be exempt from 1 V.S.A. chapter 5, subchapter 2 (the Vermont Open Meeting Law). Commission records are exempt from public inspection and copying under the Public Records Act and shall be kept confidential. (i) Notwithstanding 2 V.S.A. § 20(d), the Commission shall report its conclusions and recommendations to the Governor, General Assembly, and Chief Justice of the Vermont Supreme Court as the Commission deems necessary, but no less frequently than once per calendar year. The report shall disclose individually identifiable health information only to the extent necessary to convey the Commission’s conclusions and recommendations, and any such disclosures shall be limited to information already known to the public. The report shall be available to the public through the Office of the Attorney General. Added 2017, No. 45, § 1; amended 2017, No. 113 (Adj. Sess.), § 99; 2023, No. 6, § 196, eff. July 1, 2023.

18 V.S.A. § 7257b Emergency Service Provider Wellness Commission

7257b. Emergency Service Provider Wellness Commission (a) As used in this section: (1) “Chief executive of an emergency service provider organization” means a person in charge of an organization that employs or supervises emergency service providers in their official capacity. (2) “Emergency service provider” means a person: (A) currently or formerly recognized by a Vermont fire department as a firefighter; (B) currently or formerly licensed by the Department of Health as an emergency medical technician, emergency medical responder, advanced emergency medical technician, or paramedic; (C) currently or formerly certified as a law enforcement officer by the Vermont Criminal Justice Council, including constables and sheriffs; (D) currently or formerly employed by the Department of Corrections as a probation, parole, or correctional facility officer; (E) currently or formerly certified by the Vermont Enhanced 911 Board as a 911 call taker or employed as an emergency communications dispatcher providing service for an emergency service provider organization; or (F) currently or formerly registered as a ski patroller at a Vermont ski resort with the National Ski Patrol or Professional Ski Patrol Association. (3) “Licensing entity” means a State entity that licenses or certifies an emergency service provider. (b) There is created the Emergency Service Provider Wellness Commission within the Agency of Human Services that, in addition to the purposes listed in this subsection, shall consider the diversity of emergency service providers on the basis of gender, race, age, ethnicity, sexual orientation, gender identity, disability status, and the unique needs that emergency service providers who have experienced trauma may have as a result of their identity status: (1) to identify where increased or alternative supports or strategic investments within the emergency service provider community, designated or specialized service agencies, or other community service systems could improve the physical and mental health outcomes and overall wellness of emergency service providers; (2) to identify how Vermont can increase capacity of qualified clinicians in the treatment of emergency service providers to ensure that the services of qualified clinicians are available throughout the State without undue delay; (3) to create materials and information, in consultation with the Department of Health, including a list of qualified clinicians, for the purpose of populating an electronic emergency service provider wellness resource center on the Department of Health’s website; (4) to educate the public, emergency service providers, State and local governments, employee assistance programs, and policymakers about best practices, tools, personnel, resources, and strategies for the prevention and intervention of the effects of trauma experienced by emergency service providers; (5) to identify gaps and strengths in Vermont’s system of care for both emergency service providers who have experienced trauma and their immediate family members to ensure access to support and resources that address the impacts of primary and secondary trauma; (6) to recommend how peer support services and qualified clinician services can be delivered regionally or statewide; (7) to recommend how to support emergency service providers in communities that are resource challenged, remote, small, or rural; (8) to recommend policies, practices, training, legislation, rules, and services that will increase successful interventions and support for emergency service providers to improve health outcomes, job performance, and personal well-being and reduce health risks, violations of employment, and violence associated with the impact of untreated trauma, including whether to amend Vermont’s employment medical leave laws to assist volunteer emergency service providers in recovering from the effects of trauma experienced while on duty; and (9) to consult with federal, State, and municipal agencies, organizations, entities, and individuals in order to make any other recommendations the Commission deems appropriate. (c)(1) The Commission shall comprise the following members and, to the extent feasible, include representation among members that reflects the gender, gender identity, racial, age, ethnic, sexual orientation, social, and disability status of emergency service providers in the State: (A) the Chief of Training of the Vermont Fire Academy or designee; (B) a representative, appointed by the Vermont Criminal Justice Council; (C) the Commissioner of Health or designee; (D) the Commissioner of Public Safety or designee; (E) the Commissioner of Corrections or designee; (F) the Commissioner of Mental Health or designee; (G) the Commissioner of Human Resources or designee; (H) a law enforcement officer who is not a chief or sheriff, appointed by the President of the Vermont Police Association; (I) a representative, appointed by the Vermont Association of Chiefs of Police; (J) a representative, appointed by the Vermont Sheriffs’ Association; (K) a volunteer firefighter, appointed by the Vermont State Firefighters’ Association; (L) a representative of the designated and specialized service agencies, appointed by Vermont Care Partners; (M) a representative, appointed by the Vermont State Employees Association; (N) a representative, appointed by the Vermont Troopers’ Association; (O) a professional firefighter, appointed by the Professional Firefighters of Vermont; (P) a clinician associated with a peer support program who has experience in treating workplace trauma, appointed by the Department of Mental Health; (Q) a professional emergency medical technician or paramedic, appointed by the Vermont State Ambulance Association; (R) a volunteer emergency medical technician or paramedic, appointed by the Vermont State Ambulance Association; (S) a person who serves or served on a peer support team, appointed by the Department of Mental Health; (T) a representative, appointed by the Vermont League of Cities and Towns; (U) a Chief, appointed by the Vermont Career Fire Chiefs Association; (V) a Chief, appointed by the Vermont Fire Chiefs Association; (W) a representative, appointed by the Vermont Association for Hospitals and Health Systems; (X) the Executive Director of the Enhanced 911 Board or designee; and (Y) a member of the National Ski Patrol appointed by consensus agreement of the National Ski Patrol Northern Vermont and Southern Vermont Regional Directors. (2) The term of office of each member shall be three years. Of the members first appointed, 10 shall be appointed for a term of one year, 10 shall be appointed for a term of two years, and the remainder shall be appointed for a term of three years. Members shall hold office for the term of their appointments and until their successors have been appointed. All vacancies shall be filled for the balance of the unexpired term in the same manner as the original appointment. Members are eligible for reappointment. (3) Commission members shall recuse themselves from any discussion of an event or circumstance that the member believes may involve an emergency service provider known by the member and shall not access any information related to it. The Commission may appoint an interim replacement member to fill the category represented by the recused member for review of that interaction. (d)(1) The Commissioner of Health or designee shall call the first meeting of the Commission to occur on or before September 30, 2021. (2) The Commission shall select a chair and vice chair from among its members at the first meeting and annually thereafter. (3) The Commission shall meet at such times as may reasonably be necessary to carry out its duties but at least once in each calendar quarter. (4) The Department of Health shall provide technical, legal, and administrative assistance to the Commission. (e) The Commission’s meetings shall be open to the public in accordance with 1 V.S.A. chapter 5, subchapter 2. Notwithstanding 1 V.S.A. § 313, the Commission may go into executive session in the event a circumstance or an event involving a specific emergency service provider is described, regardless of whether the emergency service provider is identified by name. (f) Commission records describing a circumstance or an event involving a specific emergency service provider, regardless of whether the emergency service provider is identified by name, are exempt from public inspection and copying under the Public Records Act and shall be kept confidential. (g) To the extent permitted under federal law, the Commission may enter into agreements with agencies, organizations, and individuals to obtain otherwise confidential information. (h) [Repealed.] Added 2021, No. 37, § 1; amended 2021, No. 134 (Adj. Sess.), § 7a, eff. May 24, 2022; 2023, No. 6, § 197, eff. July 1, 2023; 2025, No. 116 (Adj. Sess.), § 7, eff. July 1, 2026.

18 V.S.A. § 7257c Confidentiality; peer support for emergency service providers

7257c. Confidentiality; peer support for emergency service providers (a) As used in this section: (1)(A) “Emergency service peer support specialist” means an individual who: (i) has been designated by an employer to serve as a member of an employer-based peer support program or designated by a peer support program to act as a peer support resource; (ii) has received training in providing peer support to emergency service providers who have been involved in potentially traumatizing events by reason of their employment or volunteer service; or (iii) is otherwise a member of an organized and recognized Vermont peer support program. (B) “Emergency service peer support specialist” shall not be construed to have the same meaning as a “certified peer support provider” defined pursuant to 26 V.S.A. § 3191. (2) “Emergency service provider” means an individual: (A) currently recognized by a Vermont fire department as a firefighter; (B) currently licensed by the Department of Health as an emergency medical technician, an emergency medical responder, an advanced emergency medical technician, or a paramedic; (C) currently certified as a law enforcement officer by the Vermont Criminal Justice Council, including constables and sheriffs; (D) currently employed by the Department of Corrections as a probation, parole, or correctional facility officer; (E) currently certified by the Vermont Enhanced 911 Board as a 911 call taker or employed as an emergency communications dispatcher providing service for an emergency service provider organization; (F) currently registered as a ski patroller at a Vermont ski resort with the National Ski Patrol or Professional Ski Patrol Association; (G) currently working as a mental health professional in a crisis setting who is licensed, certified, or rostered, respectively, to provide mental health services as a physician pursuant to 26 V.S.A. chapter 23 or 33; an advanced practice registered nurse specializing in psychiatric mental health pursuant to 26 V.S.A. chapter 28; a psychologist pursuant to 26 V.S.A. chapter 55; a peer support provider or peer recovery support specialist pursuant to 26 V.S.A. chapter 60; a social worker pursuant to 26 V.S.A. chapter 61; an alcohol and drug abuse counselor pursuant to 26 V.S.A. chapter 62; a clinical mental health counselor pursuant to 26 V.S.A. chapter 65; a marriage and family therapist pursuant to 26 V.S.A. chapter 76; a psychoanalyst pursuant to 26 V.S.A. chapter 77; an applied behavior analyst pursuant to 26 V.S.A. chapter 95; or a nonlicensed or noncertified psychotherapist, noncertified psychoanalyst, or any other professional that provides mental health services; or (H) currently serving as a medical examiner or assistant medical examiner as appointed by the Chief Medical Examiner. (3) “Employer” means an entity that employs or oversees emergency service providers working in a paid or volunteer capacity. (4) “Peer support communication” means an oral or written communication made in the course of a peer support session; a note or report arising out of a peer support session; or a record of a peer support session. (5) “Peer support program” means a program to provide support services to emergency service providers working in a paid or volunteer capacity. (6) “Peer support session” means an individual or group peer support session provided by a peer support specialist for emergency service providers who have been involved in a potentially traumatizing event or are suffering from cumulative or chronic emotional stress by reason of their employment or volunteer service or related to other personal matters. (b)(1) Except as provided in subsection (d) of this section: (A) any peer support communication made by a participant in a peer support session of a peer support program led by an emergency service peer support specialist shall not be disclosed by any individual participating in the peer support session; and (B) any peer support communication relating to a peer support session led by an emergency service peer support specialist between the emergency service peer support specialist and another staff member of the peer support program or between staff members of a peer support program shall not be disclosed by any individual participating in the peer support communication. (2) Written peer support communications are exempt from public inspection and copying under the Public Records Act and shall be kept confidential. The Public Records Act exemptions created in this section shall not be subject to the provisions of 1 V.S.A. § 317(e) (repeal of Public Records Act exemptions). (c) Except as provided by subsection (d) of this section, any peer support communication made by a participant or emergency service peer support specialist in a peer support session led by an emergency service peer support specialist shall not be admissible in a judicial, administrative, or arbitration proceeding, including during any discovery conducted as part of an adjudicatory proceeding. Limitations on disclosure imposed by this subsection shall not include knowledge acquired by an emergency service provider from observations made during the course of employment or volunteer service or information acquired by the emergency service provider during the course of employment or volunteer service that is otherwise subject to discovery or introduction into evidence. (d)(1) Confidentiality protections described in subsections (b) and (c) of this section shall not apply to the following information as it pertains to an individual designated to receive such information in the normal course of the individual’s professional responsibilities: (A) any threat of suicide or homicide made by a participant of a peer support session or any information conveyed in a peer support session relating to a threat of suicide or homicide; (B) any information relating to the abuse of a child or vulnerable adult or other information that is required to be reported by law; (C) any admission of conduct likely to pose a risk to public safety; or (D) any admission of a plan to commit a crime. (2) Nothing in this section shall prohibit: (A) any communications between emergency service peer support specialists regarding a peer support session or between an emergency service peer support specialist and another staff member of a peer support program; and (B) an emergency service peer support specialist or an emergency service provider participating in a peer support session from disclosing personal experiences or emotions discussed during the peer support session to the extent that such a disclosure is consistent with the participant’s obligations under the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, and its associated regulations. (e) An employer, emergency service peer support specialist, or peer support program shall not be subject to civil liability for any injuries or damages arising from the provision of peer support services or for any disclosure made in violation of this section by an emergency service provider who participates in a peer support session unless the conduct of the employer, emergency service peer support specialist, or peer support program constitutes gross negligence, recklessness, or intentional misconduct. Added 2025, No. 105 (Adj. Sess.), § 1, eff. July 1, 2026.

18 V.S.A. § 7258 Review of adverse community events

7258. Review of adverse community events The Department of Mental Health shall establish a system that ensures the comprehensive review of a death or serious bodily injury occurring outside an acute inpatient hospital when the individual causing or victimized by the death or serious bodily injury is in the custody of the Commissioner or had been in the custody of the Commissioner within six months of the event. The Department shall review each event for the purpose of determining whether the death or serious bodily injury was the result of inappropriate or inadequate services within the mental health system and, if so, how the failure shall be remedied. Added 2011, No. 79 (Adj. Sess.), § 1a, eff. April 4, 2012.

18 V.S.A. § 7259 Mental Health Care Ombudsman

7259. Mental Health Care Ombudsman (a) The Department of Mental Health shall establish the Office of the Mental Health Care Ombudsman within the agency designated by the Governor as the protection and advocacy system for the State pursuant to 42 U.S.C. § 10801 et seq. The agency may execute the duties of the Office of the Mental Health Care Ombudsman, including authority to assist individuals with mental health conditions and to advocate for policy issues on their behalf; provided, however, that nothing in this section shall be construed to impose any additional duties on the agency in excess of the requirements under federal law. (b) The agency may provide a report annually to the General Assembly regarding the implementation of this section. (c) In the event the protection and advocacy system ceases to provide federal funding to the agency for the purposes described in this section, the General Assembly may allocate sufficient funds to maintain the Office of the Mental Health Care Ombudsman. (d) The Department of Mental Health shall provide any reportable adverse events reported pursuant to section 7257 of this title and a copy of the certificate of need for all emergency involuntary procedures performed on a person in the custody or temporary custody of the Commissioner to the Office of the Mental Health Care Ombudsman on a monthly basis. Added 2011, No. 171 (Adj. Sess.), § 11f; amended 2013, No. 192 (Adj. Sess.), § 4; 2023, No. 137 (Adj. Sess.), § 7a, eff. July 1, 2024.

18 V.S.A. § 7260 Mental health response service guidelines

7260. Mental health response service guidelines (a) The Department shall develop guidelines for use by municipalities, including use by emergency medical technicians and public safety personnel, such as law enforcement officers as defined by 20 V.S.A. § 2351a and firefighters as defined in 20 V.S.A. § 3151, who are employed, volunteer, or are under contract with a municipality. The guidelines shall recommend best practices for de-escalation and for mental health response services, including crisis response services. The Department shall make the guidelines available to municipalities and publish the guidelines on the Department’s website. (b) In developing the guidelines required pursuant to subsection (a) of this section, the Department shall consult with the following entities: (1) the Department of Health; (2) the Department of Disabilities, Aging, and Independent Living; (3) the Department of Public Safety; (4) the Vermont Care Partners; (5) the Vermont Psychiatric Survivors; (6) the Vermont chapter of the National Alliance on Mental Illness; (7) the Vermont Criminal Justice Council; (8) the Vermont League of Cities and Towns; (9) Disability Rights Vermont; (10) the Department’s State Program Standing Committees; and (11) any other stakeholders the Department deems appropriate. Added 2023, No. 115 (Adj. Sess.), § 1, eff. July 1, 2024.

18 V.S.A. § 7261 Psychiatric residential treatment facility for youth

7261. Psychiatric residential treatment facility for youth (a) A person or governmental entity shall not establish, maintain, or operate a psychiatric residential treatment facility for youth without first obtaining a license from the Department of Health in accordance with this section. (b) Upon receipt of the application for a license, the Department of Health shall issue a license if it determines that the applicant and the proposed psychiatric residential treatment facility for youth meet the following minimum standards: (1) The applicant shall be a nonprofit entity that demonstrates the capacity to operate a psychiatric residential treatment facility for youth in accordance with rules adopted by the Department of Health and in a manner that ensures person-centered care and resident dignity. (2) The applicant shall maintain certification from the Centers for Medicare and Medicaid Services under 42 C.F.R. §§ 441.151–182. (3) The applicant shall maintain accreditation by the Joint Commission or other accrediting organization with comparable standards recognized by the Commissioner of Mental Health. (4) The applicant shall fully comply with standards for health, safety, and sanitation as required by State law, including standards set forth by the State Fire Marshal and the Department of Health, and municipal ordinance. (5) Residents admitted to a psychiatric residential treatment facility for youth shall be under the care of physician licensed pursuant to 26 V.S.A. chapter 23 or 33. (6) The psychiatric residential treatment facility for youth, including the buildings and grounds, shall be subject to inspection by the Department of Disabilities, Aging, and Independent Living, its designees, and other authorized entities at all times. (7) The applicant shall have a clear process for responding to resident complaints, including: (A) the designation of patient representative pursuant to section 7253 of this title; (B) a method by which each patient shall be made aware of the compliant procedure; (C) an appeals mechanism within a psychiatric residential treatment facility for youth; (D) a published time frame for processing and resolving complaints and appeals within a psychiatric residential treatment facility for youth; and (E) periodic reporting to the Department of Health of the nature of complaints filed and action taken. (c) A license is not transferable or assignable and shall be issued only for the premises named in the application. (d) Once licensed, a psychiatric residential treatment facility for youth shall be among the placement options for individuals committed to the custody of the Commissioner under an order of nonhospitalization. (e) The Department of Health shall adopt rules pursuant to 3 V.S.A. chapter 25 to carry out the purposes of this section. Rules pertaining to emergency involuntary procedures shall: (1) be identical to those rules adopted by the Department of Mental Health governing the use of emergency involuntary procedures in psychiatric inpatient units; (2) require that a certificate of need for all emergency involuntary procedures performed at the psychiatric residential treatment facility for youth be submitted to the Department and the Mental Health Care Ombudsman in the same manner and time frame as required for hospitals; and (3) require that data regarding the use of emergency involuntary procedures be submitted in accordance with the requirements of the Department. (f) The Department of Health, after notice and opportunity for a hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under this section. The notice shall be served by registered mail or by personal service setting forth the reasons for the proposed action and fixing a date not less than 60 days from the date of the mailing or service, at which the applicant or licensee shall be given an opportunity for a hearing. After the hearing, or upon default of the applicant of licensee, the Department of Health shall file its findings of fact and conclusions of law. A copy of the findings and decision shall be sent by registered mail or served personally upon the applicant or licensee. The procedure governing hearings authorized by the section shall be in accordance with the usual and customary rules for hearing. Added 2023, No. 137 (Adj. Sess.), § 8, eff. July 1, 2024.

Source: Vermont General Assembly (legislature.vermont.gov)URL: https://legislature.vermont.gov/statutes/chapter/18/174Fetched: 10/21/2026