Department of Mental Health details system of care, crisis services, and children's mental health initiatives

Deputy Commissioner Samantha Sweet and Laurel Olanz, director of Child, Adolescent and Family services at the Department of Mental Health (DMH), told the Senate Health & Welfare Committee that DMH oversees Vermont's mental-health system of care and operates two state facilities while contracting with 10 designated agencies and two specialized service agencies.

Why it matters: DMH provides crisis response, inpatient and community services used by thousands of Vermonters; the department flagged workforce pressures, bed capacity and federal compliance obligations that affect treatment access.

Sweet said DMH employs 302 people, of whom 233 are facility-based staff, and manages a budget the department described as approximately $326,000,000 to support mental-health services for more than 25,000 Vermonters. She told the committee the bulk of DMH spending supports community-based services delivered through the state's network of designated and specialized agencies.

The deputies described DMH's tiered system of care. At the community level DMH funds designated agencies for prevention, outpatient and peer services; crisis supports include 988 and enhanced mobile crisis teams with peer staff; intensive residential and psychiatric residential treatment are mid-tier; secure residential care (a 16‑bed River Valley Therapeutic Residence in Essex) and inpatient hospitalization are the highest-acuity services. Laurel Olanz said River Valley replaced the Middlesex Therapeutic Community Residence and noted an increase from seven to 16 secure beds in Essex.

DMH staff discussed efforts to expand alternatives to emergency departments, credential peer staff on mobile crisis teams (a credentialing milestone set for July 1 in the presentation), and to stand up a psychiatric residential treatment facility (PRTF) for youth that the department hopes to have online with 15 beds in the near term.

On youth mental health, Olanz cited population-level survey results and said national and Vermont surveys show rising need since the COVID pandemic. "Twenty-three percent of Vermont high schoolers indicate that their mental health was not good most of the time, and 11% said it was not good all of the time," Olanz said, citing Youth Risk Behavior Survey data.

Sweet referenced the federal EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) Medicaid mandate and recent CMS guidance emphasizing compliance for children and youth with mental-health and substance-use needs. She and Olanz described the Vermont Consultation Psychiatry Access Program (a merged child and perinatal psychiatry consultation service) as a federally funded effort that gives primary-care and OB providers access to psychiatric consultation and social-worker support; the program has provided over 1,000 consultations to pediatric practices since June 2022, they said.

Committee members asked about staffing shortfalls. Sweet acknowledged acute-facility reliance on traveling staff and said DMH would follow up with the committee if the document referred to in a prior briefing requires clarification. "That probably includes our acute facilities," she said, when a statistic that DMH was "down 70%" was raised; she offered to return with more precise staffing numbers.

Ending: Sweet and Olanz said DMH is engaged in school-based initiatives (Project AWARE), pediatric consultation programs and crisis-system expansions; they offered to return with additional detail on Medicaid-funded school services and workforce metrics requested by the committee.