Committee hears survey showing high rates of co-occurring mental-health needs among people in developmental services

Delia Yorkin, executive director of Champlain Community Services, told the House Human Services Committee on Jan. 30 that nearly half of Vermonters receiving home- and community-based developmental services have a co-occurring mental-health diagnosis and that trauma is widespread among the population the system serves.

"About half the people served in developmental disability service systems, high 45 percent or so, have a co-occurring mental illness," Yorkin said, summarizing results from a point-in-time survey her network conducts each October. She said the survey tracks five domains—co-occurring mental-health diagnoses, substance use disorder, complex health issues, trauma history and homelessness risk—and was designed to demonstrate the complexity of people in services.

Yorkin said the survey team defines "crisis" as "psychological, behavioral and/or emotional dysregulation that would result in acute life disruptions within the next 45 days," and that roughly 15 percent of people in services are in crisis at some point in a year based on the point-in-time snapshots the agencies take.

The presenters told lawmakers that service systems once had clearer lines between developmental services and mental-health care and that those silos, together with narrowing entrance criteria and higher assessed acuity among new entrants, mean agencies now see a higher-need caseload. "When we're serving people in developmental services, we're looking at the whole person," Yorkin said, urging policymakers to recognize the overlap of disabilities, mental illness and other needs.

Panelists also outlined the limits of crisis-stabilization resources. Yorkin described Vermont's Crisis Intervention Network (DCIN) as a small program that "has 3, I believe they're able to support 3 individuals," and cautioned that the state has not reinvested the resources it once had for higher-level stabilization.

Committee members thanked the presenters for the data and asked how the new fee-for-service payment model for crisis services will ensure authorization and access. Yorkin said authorization is required even in a fee-for-service model and urged careful monitoring as payment reform moves forward.

The committee placed the presenters' written materials into the public record and said it would consider the survey's implications as lawmakers work on budget language and policy choices tied to behavioral-health and developmental-services integration.