Vermont’s 2017 legislation session is in full swing and this year there seems to be an unusually large number of bills that have direct impact on mental health. What follows is a short list and update of the legislation as well as a few personal thoughts.
Improvements to the state mental health system (S90). The current crisis that has many Vermonters with 
emotional/behavioral struggles stuck for long periods of time in emergency departments and hospitals has not gone unnoticed. While there continues to be discussion about short-term interventions, people are also looking at the big picture. S90 requires the Deputy Secretary of Human Services to coordinate a prevention and treatment program for victims of child trauma and adverse events. It includes a statewide home visiting program and implementation of evidence based parenting and wellness programs. Our Vermont Family Based approach is listed by name. As you might expect, those of us in child psychiatry are strongly in support of this legislation.
Psychologist Prescribing Privileges (H280). This bill would allow psychologists the ability to prescribe psychiatric medications after some additional training. While on the surface this might appear to be a way to improve access to mental health care, there are concerns about the level of training needed to prescribe medications safely and specifically the need not only for pharmacological knowledge but true medical training as well. This bill is now at the House Committee on Health Care.
Kuligoski clarification and possible reversal (S3). As many people know, a VT Supreme Court decision known as the Kuligoski ruling drastically increased the circumstances for which confidential patient information would need to be breached for people who might even be at chronic risk for harming others (the previous standard was for imminent risk to identifiable people). This judgment has left mental health professionals confused about what their responsibilities now are. Some officials from the state believe that the ruling is partially responsible for the increased back-up of patients in emergency departments and hospitals. This bill aims to bring the “duty to warn” closer to the original standard. While this bill is quite welcome by many patients and mental health professionals alike, some new language in the bill about the need to disclose “all necessary information” to caretakers at discharge has led some people to wonder how much of an improvement the bill actually would be in its present form. This bill is out of the Senate Judiciary Committee and going to the floor.
Medical and recreational marijuana (H170, H207, S16). Despite recreational cannabis being voted down last year, it is back again just a year later in many different forms. While the main legalization bill no longer opens up a broad commercial market, it does allow Vermonters to grow quite a bit of their own marijuana legally. Many health professionals continue to voice concerns about the public health effects of legal cannabis, particularly when our state’s substance abuse resources are so limited. This bill is currently in the House Judiciary Committee and sponsors are trying to fast track it so that it is not reviewed by any health care committee. A separate bill regarding marijuana expands the allowable indications, including PTSD. Not only is there a lack of research evidence that cannabis helps PTSD but there are studies demonstrating that over the long-term cannabis worsens things like aggression, anxiety, and other types of substance use. S16 is now at the House Committee on Human Services. H207 would also allow psychologists to sign the medical verification form.
This list doesn’t even include other legislation regarding nutritional requirements for children’s meals (S70) or raising the tobacco smoking age to 21 (S88), and many other healthcare related bills.
These potential actions could have major impacts on the health of Vermonters and our elective officials are eager to learn from the medical community and hear our views. Especially in a small state like Vermont, voicing your views to your legislators and letting the relevant committees know your science-based opinions can make a big difference so please speak up. You can find more information about the specific bills here.