DMH says River Valley renovations will enable emergency procedures and involuntary medication; not a distinct "forensic" unit

The Department of Mental Health told the Corrections & Institutions Committee on May 15 that renovations under Act 137 will allow River Valley — the state's locked residential facility — to use emergency involuntary procedures (EIPs) and court-ordered involuntary medications and to admit some people directly from the community when clinically appropriate. DMH officials said the changes do not create separate "forensic" beds reserved only for people referred from the criminal justice system.

"River Valley is the only physically secure residential facility in Vermont," said Kara Barber, general counsel for the Department of Mental Health. "Everyone there is involuntarily in the custody of the Commissioner of Mental Health on what's known as an ONH or an order of non hospitalization." Barber said Act 137 directed the department to revise licensing rules to permit episodic EIPs and to permit court-ordered involuntary medications in the River Valley setting.

DMH explained the policy change as three related modifications from Act 137: (1) allow emergency involuntary procedures (seclusion, restraint and emergency medications, collectively EIPs) under a revised rule; (2) allow court-ordered involuntary medications in River Valley where clinically indicated; and (3) enable direct admission from the community for people who require intensive, secure residential services but do not meet hospital-level care.

Barber said the change reflected both clinical and system-level gaps. Previously, people who needed brief seclusion or emergency interventions but did not meet hospital criteria had to be transferred to inpatient hospitals — an outcome DMH said sometimes produced poorer clinical continuity. "Before, because we couldn't do EIPs at River Valley or Middlesex, it meant we had to remove them from the facility and we had to send them to a hospital, which in most cases was not good clinical care," she said.

Barber and other witnesses also clarified a persistent point of confusion in prior committee testimony: River Valley does not contain beds that are labeled exclusively "forensic" by admission source. DMH said placements and treatment decisions are based on clinical need rather than the court or civil origin of a case. "We don't differentiate treatment or placement for those folks based on what door they came through," Barber said. "It's really based on their needs."

Committee members raised questions about whether the renovations being funded in the capital bill were limited to an "eight-bed forensic wing"; DMH witnesses said the seclusion/restraint suite will be located in one wing for operational reasons but that EIP capacity and court-ordered medication authority will apply where clinically necessary across the River Valley facility. DMH staff also noted that the agency had shifted course after earlier legislative discussion of a forensic facility: the draft bill S.192 that some committees considered earlier in the session changed in negotiation and was enacted as Act 137 with different tools and authorities.

Witnesses emphasized that the state does not currently operate a competency-restoration program and that creating a forensic system involves different trade-offs — including Medicaid funding considerations and program design. Barber said DMH and partner agencies are studying best practices for competency restoration but that Act 137 focused on immediate, implementable tools for River Valley and the DMH system.

The committee did not take formal action on the renovations or on broader forensic-system questions during the hearing. Several members requested follow-up briefings and historical documentation of past committee conversations and legislative language after repeated questions about what prior testimony and bill drafts had proposed.