State reports expansion of mental-health urgent cares and mobile crisis teams; proposed shift of a Howard Center outreach role draws municipal concern

Deputy Commissioner Samantha Sweet and Commissioner Emily Haas described the state’s growing set of alternatives to emergency departments — often called mental‑health urgent cares — and the statewide rollout of enhanced mobile crisis teams that can be dispatched by 988.

Sweet listed existing urgent‑care sites and programs: Interlude (Middlebury), Front Porch (Northeast Kingdom Human Services), Access Hub (Washington County), Howard Center’s Mental Health Urgent Care (in partnership with UVM Medical Center and local partners in Burlington), Psychiatric Urgent Care for Kids (Bennington County/UBS), EPIC (Lamoille County), and youth-focused urgent care in HCRS/Windsor County. She said hours vary and that expanding evening and weekend hours remains limited by staffing.

Committee members pressed for utilization and outcome data. Sweet said many urgent cares opened in the last three to six months and that the department has counts of how many people were seen and how many required referral to emergency departments; the department said it would share those data with the committee.

On 988 trends, DMH staff said that 988 calls peak in the evening, with Monday and Tuesday showing higher volumes; many 988 contacts resolve by phone, and calls taper after about 9 p.m. Sweet and Haas said enhanced mobile crisis teams (two-person teams, often including a peer) are available to respond in person when needed and may be dispatched by 988.

The department also presented a heat map showing where urgent cares are located and described efforts to align urgent‑care hours with typical emergency‑department arrival times (3–6 p.m. on weekdays) to reduce ED wait times. Officials said hospital wait hours have returned toward pre‑COVID levels but that staffing constraints keep some inpatient beds closed.

A substantial portion of the hearing focused on a proposed reallocation of a Howard Center Community Outreach position currently funded by a state grant. DMH officials said they plan to move some grant-funded local outreach roles into the enhanced mobile crisis response model so those staff can bill under Medicaid when appropriate; officials said data indicate many contacts handled by the outreach worker were phone contacts and could be answered through 988 or mobile crisis rather than a dedicated local grant position.

Municipal leaders and committee members pushed back. Several committee members said the Howard Center outreach worker provides rapid, informal, community-based contact (for example, “on the sidewalk”) that they fear will not be replicated by a centralized 988/mobile‑crisis dispatch model. One member said the funding shift effectively transfers costs to municipalities if they want to preserve local outreach. Department officials said their intent is not to reduce services but to integrate staff into broader mobile crisis teams so that the same person can be deployed from the community rather than sit in an office waiting for calls.

Staffing shortages were a recurring theme. DMH told the committee there are still several hundred vacancies across the designated agency system, though the department reported that vacancies are fewer than in prior years and that hiring classes and incentives (shift differentials, bonuses, and alternative shift models) are helping. DMH acknowledged gaps in evening and overnight urgent‑care hours and noted enhanced mobile crisis exists to respond when urgent‑care sites are not open.

The department said law enforcement can transport people directly to urgent‑care sites in some areas, though the practice is not yet widespread and policies and hospital regulation can complicate siting urgent cares adjacent to emergency departments.

Committee members asked DMH to provide data on urgent‑care throughput (number seen vs. referred to ED), 988 dispatch rates, and the effect of mobile crisis deployments on ED wait times.