Department Overview

Priority Service Functions of DMH

The Department of Mental Health’s (DMH) commitment to direct services and community-based mental health care and treatment is reflected in the following priority areas. 

• Direct Service: Operation of the Vermont Psychiatric Care Hospital and the Middlesex Therapeutic Care Residence.
• Community Oversight: Oversight of the Designated Agency (DA) community-based mental health service delivery system including residential programs. Oversight of in-patient services in Vermont’s Designated Hospitals.
• Investment in peer support services in all treatment settings
• Central Office Operations: Central office management of federal, state and grant opportunities, exploration of new treatment approaches and evidence-based practices in the field of mental health treatment and collaboration with providers on practice improvement initiatives. 

Central Office Operations

The central office of the Vermont Department of Mental Health ensures that internal and external program operations pursuant to its statutory responsibilities under 18 V.S.A. Chapter 173 are adequately resourced, monitored, and that development activities sustain and promote the existing public mental health adult and child services network.  Operations functions include administrative support, financial services, legal services, provider monitoring, care management, utilization review, quality management, research and statistics, policy, and community housing. 

Administrative Support Unit

The Administrative Support Unit staff is often the first point of contact and triage for incoming inquiries from consumers, family members, and service providers.  Administrative Support Services staff responds to the daily internal and external communication flow with operations and clinical services staff, AHS and our community partners.  Support staff work closely with program staff in the development and execution of service provider contracts and grants, as well as, ordering, production, document management, and other clerical services necessary to support their respective units within the DMH.

Business Office

The DMH Business Office works closely with all DMH staff at its three locations, DMH Central Office, the Vermont Psychiatric Care Hospital, and the Middlesex Therapeutic Community Residence. Additionally, DMH’s financial work requires working closely with numerous divisions of State Government, Vermont District Agencies, the Federal Government, and vendors. It is the duty of the DMH Business Office to assure fiscal compliance to State and Federal guidelines. This facet of DMH is responsible for overseeing the DMH budget, accounts receivable, payroll and expenses, accounts payable, implementing and enforcing financial controls, fiscal audits and compliance, and financial reporting. DMH Business Office staff track and monitor the DA provider system and community-based advocacy, family, and consumer-run organizations in accordance with existing agreements; contracts and grants.

Legal Services Unit

The DMH Legal Unit is comprised of attorneys, paralegals, and an administrative staff from the Attorneys General Office. It handles all litigation in the Vermont Superior Court Family Division concerning applications for involuntary treatment (inpatient and outpatient) and involuntary medication. The unit acts as a liaison between DMH and the county prosecutors around criminal cases involving defendants subject to inpatient and outpatient competency and/or sanity examinations and represents the Department in appeals to the Vermont Supreme Court.  It supports the DMH with legislative and policy review activities and various other proceedings requiring attorney representation. 

Care Management

The Adult Care Management Unit reviews the use and authorization of inpatient care for adult clients with the most intensive, involuntary mental health service needs, as well as all Intensive Residential Residents living in the community.  Care Managers also oversee individuals on Orders of Non-Hospitalization and assist Designated Agencies in addressing unmet needs in the community.  The team also supports the Designated Hospitals to facilitate movement to clinically appropriate alternative care settings and timely aftercare to community services.

The Children’s Care Managers authorize access and Medicaid funding for higher levels of out-of-home care; provide feedback and technical assistance for local providers as to the most appropriate course of action on complex family needs; provide extensive case coordination with system of care partners; work on initiatives related to System of Care development, including early child and family mental health, school mental health, and integrated health care; review quality of DA/SSA child, youth & family services; and promote best practice approaches for promotion, prevention, intervention & treatment.

Adult Services

The Utilization Review (UR) team is responsible for authorization of Medicaid funds for psychiatric hospital stays for adults enrolled in CRT or Adult Outpatient programs at the Designated Agencies and Pathways Vermont, for adults involuntarily hospitalized, and for adults determined to need intensive hospital services (Level 1).  The UR team’s responsibilities include initial and ongoing reviews of clinical information submitted by hospital staff to determine medical necessity of services and level of care appropriate to address the individual’s treatment needs. The UR team communicates regularly with hospital staff and the DMH Adult Care Management team to review care plans and to identify needed community services to facilitate discharge planning.

Access to safe, affordable housing is critical to the well-being of Vermonters with disabilities and who live on extremely limited incomes.  DMH assumes a leadership role in the development and preservation of, and access to affordable housing.  Staff coordinates and supports the continuation of existing HUD funding and actively pursues opportunities for new funding for housing.  These activities require close working relationships with Vermont’s not-for-profit housing developers and with the local and state housing authorities. Housing assistance for persons in acute care settings who are homeless is a priority.  In addition, DMH works closely with the shelters and service providers who assist Vermonters who are homeless to gain housing and supports.

Interagency Collaborations Team

Interagency collaboration efforts bring state government and local communities together to ensure holistic and accountable planning, support, and service delivery aimed at meeting the needs of Vermonters across the lifespan.

We have specific initiatives for:

• Integrating and coordinating services for children, youth, and families
• Trauma Prevention and Resilience Development
• Suicide Prevention
• Health Integration
• Strategic Planning

Policy

The DMH Policy Team provides expert guidance, support, and analysis of Mental Health Policy and compliance to the Department of Mental Health, the Agency of Human Services, the Legislature, and other public and private entities. The activities of the DMH Policy Team aim to assure timely development and implementation of effective and innovative policy that advances the Department’s goals.  The team includes designated Legislative supports and liaisons for the DMH. The team also leads, facilitates, and participates in efforts toward delivery and payment reform, provides guidance regarding the Building Flourishing Communities initiative, maintaining a trauma-informed system of care, and Suicide Prevention efforts.

Quality Team

The purpose of the Quality Team is to assure that all programs and services funded by the state:

• Comply with regulations (both state and federal),
• Achieve desired, equitable outcomes,
• Provide accessible, high-quality services, and
• Reduce or eliminate harm.

We provide oversight of community mental health centers (in Vermont, we call these Designated and Specialized Service Agencies) as well as inpatient psychiatric units at hospitals. This includes but is not limited to:

• Providing support for committees to get input from individuals and families with lived experience receiving services,
• Leading continuous quality improvement projects,
• Data visualization and reporting,
• Specialized review of specific evidence-based practices, and
• Review of undesired outcomes such as client grievances or appeals, restraint, seclusion, and critical incident reporting such as deaths, missing persons, or serious medical events.

Research and Statistics Unit

The Research and Statistical Unit personnel provide routine and ad hoc data review and analysis from various provider services information and data submissions.  The activities include agency reviews, records documentation minimum standards, and tracking agency or hospital information reporting for the DAs, SSAs, and Designated Hospital psychiatric inpatient programs.