system And the justice system in terms of what those two rules mean So that's part of You brought up a tremendous point. I think in terms of free trial services other states have county jails And those county jails have been working on what's called a stepping up initiative, which is trying to find alternatives for those who are mentally ill Rather than having them held in statistically Those with mental issues are held longer on detention than the Rest of the Much of it because where else do you what else are we supposed to do with it?  They stay Because there was no super place jail Um, you know, it's just So those are some of the things that we also need to look at I think is but Any ideas you have we'd be happy to hear them and work with eric and katie on the legislation Eric and katie and the ones beside me I have a question. I don't know that you can answer if it goes back to k help what you're talking about Dual status And one partner that is really clear. So the department won't help. Who's the other partner? I'm tk hals proposal Is it the courts? Who's the other partner for dual status dmh is very clear. They're one partner. Who's the other partner? Well So just to be clear what I was proposing was the statute needs to recognize that there are two purposes There's the these are the patient and protection of the public The second question is whether you need two different departments of government to actually administer those two separate considerations Uh, in any way the history of viewing that say the useful offenders where we have the department two of their families and Part of uh corrections both monitoring one individual Can't suggest that's the most efficient use of any of those resources Um So that then needs me to my next slide Where is this person? The patient or the defendant or whatever name you want to give the person Where is that person housed and under whose jurisdiction? Is it a state facility or is it something we contract out of the decimated agency? Let me let me answer that with a legal term Part of this is you have two systems that use it that uses different terminology You're talking about the same problem, but with different terminology and frankly different rights Um, and you have that tension that that exists And you know, I think anytime you can have greater coordination and look, you know from my time at states attorney We would do o and h is quite often the order of non-hospitalization It's side off on it And that's kind of the last year You heard of it and that's not a reflection on dmh It was more of a reflection. I think on the prosecutor at least on me because you said, okay This is now off my desk and I think that's a fundamental change that we have to be willing to say that we all have skin in this game that we can kind of Perhaps redefine and expand a definition of public safety while maintaining or respecting people's privacy rights dmh's roles a health care provider Um, so I think anytime we can have increased and I think we're doing that there needs to be more done And I think frankly some more training Is always helpful. This is confusing and it's and it's I think amplified When you're that prosecutor or the defense attorney And you're in the courtroom and you get 30 pieces ready to go and you get an evaluation coming in your Ordered by the court and it's it is the outpatient is inpatient decisions can be made and you move on to the next case Because that's your job and So I think you know senators you said fall through the cracks. I think that's an issue, but I really want to reiterate the point that Mental illness permeates the entire criminal justice system And it's not just these that we're going to use the term major mental illness. It's everybody And the pretrial services is working that says to me that the courts the defense the prosecutors Are buying into it that this that the numbers That we believe in community mental health treatment And then we have to create a space I think for a limited view based on the numbers Of what we're dealing with but then it's done on a case-by-case basis because for me It's always that issue of competency and then you're looking at the evidence Which is a question of fact on the issue of sanity So if you look at your numbers And inpatient for the evaluations were around 50 20 were deemed not confident that could change the next day. Yes, 20 were deemed insane So you're really talking 20 placements 25 placements, maybe 30 placements Are those physical beds that are stayed on? They could be But I don't know the answer to that question. I want to complicate matters more by Give me in also 18 We had 10 confident but 10 insane And so the question is Were those were those 10 cases? To verdict or was there a resolution and are those 10 people who we said are insane? In doc or they in dmh and that leads to my next question based on competency I would argue they may be in doc got tested That leads to my next question then under whose custody dmh or doc because that determines state hospital Secure residential or correctional facility. Okay, it's going to determine on the order of the court Were they sentenced if they're sentenced they're going to be under doc's custody But if they can't be sentenced because they're insane then it's generally going over the hospitalization side and dmh So it seems to me that Just a statement or Molly couldn't be here But it seems to me that then we're going to be running Dual system Accomplishing the same goal and that doesn't seem to seem like a very productive outcome for Either the patient Inmate or the state Well, I think I think the systems are are fundamentally different the criminal justice system is a public safety system Department of mental health is a is a health care system or a health care provider We have said that they are a mental health provider in this state Are the public's safety ramifications? Yes But that's not dmh's role dmh's role is to determine whether or not somebody is in need of treatment And then what is the level of setting based on that that need in the least restricted You go from being a patient to an inmate And that's a very different expectation In terms of treatment. Yeah I realize the correction Bull is rehabilitation, but what you're considered an inmate while you're incarcerated And if you're in mental health you're considered a patient which says you know Very different You might be in a secure facility You may be in a secure facility, but the focus But the focus is not on your victim There's a certain We put into the corrections model a certain amount of focus on the victim Through restorative justice or whatever processes We notify victims when somebody's released from jail or somebody is gonna You know to have a court appearance or whatever we notify the victim In the mental health system, we give no notice to the victim And that's part of the frustration for many of the victims Is that they have no idea what's happening to the person who Did that either to their family member or to them if they survived the attempted murder or whatever the act was and I don't think that In this day and age That's appropriate. We need to at least I mean hearing about a sheriff Who's being harassed by a particular individual And a sheriff only finding you know Comes home and this person that's at his door It's just unacceptable in this day and age I think it's who's us to try to We may not get I mean, we've been dealing with this for years. It's not like this hasn't been enough Focus, I mean it's a closeout scheme for example We all dealt with that Difficult problem a few years ago Something I guess today But I think we we need to deal with this in the next session of the legislature and I'm appreciative having you know Senator Clarkson bringing this This dining room conversation with Data 20k I'll leave this to this today at least we're at least preparing something ahead of time. So Respective committees get to deal with this. We know what we're talking about Representative Cooper has a question I'll try to figure out if I can frame it as a question And I Very much appreciate you saying look at the data And I'm really do you think we need to look at the data and Allow that to help us inform good policy decision I think it's interesting if I I believe that if you went further back and the data that you've pulled up You will see that there is in fact a pretty big jump in the numbers of Um In both categories so something happened and that's interesting and I think we ought to understand Why there was a change? We need to respond to what's happening today, but we need to understand why it changed So let's be data driven. Um, I also Really appreciate the observation about how mental health issues pervade the entire system and I I said perhaps here is my question of Yeah, we we have a number of issues to resolve Which one do we begin to tackle first? Uh, great question. Um, I would say, you know on the numbers of what happened, I think, you know What we talked about that that pre-trial that mental Mentally ill population that perhaps does arise that major mental illness and the competency and insanity emails I think the way you're looking at you look at the opiate To use a lot of current issues here Where you had the substance abuse disorder and you had a mental illness And because this that they are all linked to go further back You should we should start talking about the issues of trauma and all the I mean This is what the criminal justice system Is not designed to do but is doing and that's why we're in the position. We are not just in remand, but frankly in this nation And so what you do first? I think you have to identify the scope of the problem And I think that's that's the data And that should be that should drive it because I I do have an adverse reaction when we talk about facilities That really should be driven by the light and numbers and numbers and public centers, you're right, you know we DMH is a health care provider And you're gonna have a lot of federal laws like HIPAA that are implicated as a result of that status and the federal funding that Should be addressed. I'm sure commissioner's role will talk about it much more healthily than I can but Understanding that there are public safety implications as a result of how they got there And that I don't have an answer to it and that's going to take a lot of work. I think a lot of I think we got to be really precise while Protecting people's rights, but also making sure That we're sharing the realms of information as best we can So victims understand the status of the situation But I think that it should be data driven and I think that's where I would start and how do we part of that? Oh boy, I don't even know if it's a question, but thank you And identification of the community mental health system is key in managing people's lives It's absolutely important and uh, both the house and the senate have worked on that as well but Mental health regardless of where the individual is is mental health And so we need to ensure that we have appropriate treatment facilities across the board. I think that's what i'm hearing you say and um So any help that you can give us in promoting that then Providing the needs providing what is needed within communities. I think is really critically important I appreciate that and I was reading somewhere and I think after I read where you get the legislature Did the redesign? The mission is correct It is a continuum of care with these two systems that should complement So the intent is there and I think we I think we did the framework Because it isn't exactly the continuum of care from the community To corrections to pre-trial services looking in the community To dlc and jail beds and to secure facilities with dmh and now we're just going to make sure that we have that Compliment that all the puzzle pieces are actually fitting together But I think really again the legislature put us on the right path to do it And now we're going to just kind of put all the pieces together, but it's the continuum of care Thank you. Thank you senator me Thank you for having me First I'd like to say that These I agree with much of what was has been said Really can't disagree with much that A g donovan had to say during the course of extra money We run into the same clientele I'm looking at them from Different different points in the justice system And ultimately the crossover between the justice system and the mental health system Is one that actually has been pretty well defined over a long period of time But it's only when you have unique situations that arise whether it is incidents of three cases being Dismissed or some particularly heinous crime that people decided you're going to take notice And you know I have been in this working in the system for over 31 years and As defender general for the last 18 But I've had a lot of experience working on the criminal justice side with exactly the clients that You're talking about and senator sears brought up The tea case from from then That's the individual who was then In the mental health system since the day of her Her since she's been taken into custody because the mental health system has determined and continues to review Um and determines that she's a danger to herself or others And uh and is doing it just as the statute requires The thing that I think is unique about This situation that that's brought us all here the three dismissals that Is attorney george appropriately Submitted and I think ethically had no choice but to submit Um is that they all came at once on the heels of the case The vergoni days that was still pending general comment particularly about but that also Had mental health significant mental health implications With it. So it's it became part of the public mindset in a very serious case With three other cases that were You know essentially resolved Shortly thereafter and has brought attention to the issue But these types of cases go on in the criminal justice system all the time All over the state state's attorney kato talked about his situation with the case there and I've Had handled many of these myself when I was litigating I don't see the system as particularly broken As far as the analysis of what people belong in the mental health system and what people belong in the criminal justice system The biggest issue really for me has to do with placement issues Once determinations are made do we have the resources and Available beds or other whether what level of security there are they're there is available to keep them Consistent with what they're What they're what their needs are from a from a mental health standpoint? I also think that one of the issues and I'm willing to suggest that We get into the private Mental health diagnosis of individuals who are in the department mental health custody But there's clearly a lack of understanding of what goes on Otherwise the furor wouldn't be so great And There are times when the lack of transparency comes at the expense of the client and That to me might be a way that some of these beers can be a leg Going forward I don't see fundamental issues with the way the system works And I'd be happy to answer any questions that anybody has What you said You believe that state attorney george's actions for ethically and The only choice that she had both I don't know what more to legally and ethically legally and ethically Is that a But that outcome What happens to those individuals those are individuals who go into the mental health system And they have to continue to review over a period of time just as in the tea case as to whether or not they Have major mental illnesses and are in danger themselves or others and they have provided treatment As necessary and they have legal representation through Legal aid for any of the issues that arise in that part of the system But it was a good tea but She had 91 or 92 But I don't think she was ever Came to a trial situation Correct And those are those are cases where you can be incompetent and insane. You're insane.  Yeah and you're unable to Participate in your own defense because of your major mental illness and the result once you are In that case a hospitalization order is to have that continuing review until you're deemed able to not have So it's possible that the people in the chitin case this could be In the system for a long period. It's absolutely It's also possible. They can be out 90 days theoretically, yes But you know those are that's the evaluations of the people you have working in mental health I mean, I think it would be highly unlikely that people are going to be watching at the door in 90 days But Theoretically it's possible What about some of those other cases going on? I asked Say that you're okay. You know about the cases that don't like to that one and that many of you may not even know who they are Whatever reason they they end up in my health system on the correction system there back all you know yelling calling 911 I mean, I have a case of A That was this guy making noise every time he turned around That he got charged with his partner's car alarm every You know try to come back to voice the other guy. Yeah Well, you know, they're all they're all increased mental illness and the standard is you have a major mental illness and are you are Are you a Danger to yourself or others once you get to the point of hospitalization or not hospitalization Obviously, someone's starting tonight exactly the Danger to others even though there are no instances that those are things that you know when you when you live in the world You have to deal You know, you can't anybody by the way, whether this is whether it's a homicide case or a false alarm case Has to understand that These folks Are always in our system You know, they're either in the criminal justice system doing it or they're out of the christmas And there's a range of them from car alarms to homicide people who have who are mentally ill permeate all parts of our life And you know, there has to be some recognition That we aren't going to respond the same way to all of them the same Do you have Do you have any idea how many beds we need in the mental health system? No, no, no, I have no idea what's going on You know once they once we they have a hospitalization or non-hospitalization work Then the defender general's office is done with the case. So Do you have an opinion? Yeah, I do. I think it is important to know like as defense attorneys We are often trying to facilitate getting our clients into mental health beds And it is often frustrating that there are not enough. So I can't tell you how many but I can tell you more For you more Thank you I think you need to be clear You're saying what happened there because I think everybody goes level one acuity and that's not what we need We need step down fits I think that's an important part of it. I mean this whole discussion gets framed around the most traumatic cases That's not the bulk of the work that the system does the work of the work that the system does Is not dealing with the murders the bulk of the work that the system does Is dealing with the much lower level offenses that still have that those mental health problems associated with If all is not a resource question, you may ask Oh, it's not going to be a problem Let's hope that somebody asks you a resource question I'm trying to prove That's a little between the property and the data We'll have that argument some other time Subjectively, buddy Did you have a question? Yes, and I'm asking you because I don't I could have asked anybody else because almost everybody Is raised it and I don't think anybody really has the kind of jurisdiction here But we've talked about The need to have transparency and to shine light and to allow the victims to know and have insight into what's going on at the same time This state has and I'm very proud of the role that we have played in saying Mental health issues are just a component of health issues And that we should treat mental health issues just the same way we treat physical health issues So how do we reconcile that? Privacy issue that we insist upon for physical health With the issues that are being raised here and and and I don't want to lose that I guess now I'm saying my colleagues I don't want to lose that value. It's a very very important value that we've fought hard for So how do we reconcile that? You know, there was something that I was thinking a little bit about that issue and coming in because I One of the things I think defense council always likes to do is to try to educate the public About what's going on why it's going on and then they're less fearful of the process the result and Get a better understanding of what what is going on as a as a fair thing and something with the laws being applied One of the areas of the law that we Do this kind of hybrid sort of privacy issues with strict Sort of categories involved in the juvenile system Where victims do understand what's going on through their perpetrator, but By the same token, they're bound by the law that it's a crime to disclose Um the information From a juvenile proceeding outside of that. So you're serving an interest of the victim and you're also Maintaining the appropriate confidentiality of proceeding that should remain confidential now in that case It's a juvenile case and in these cases it would be mental health or or by the light and So we do this in the law and But anybody who's looking for You know 100 percent or zero failure in a system Should not be to get any of our systems or anybody else They're going to be they're going to be slips because people are administering them, but the juvenile system is one that When you're looking at sort of hybrid notification with safeguards Is one that may satisfy some of those interests Okay, that was a Again a similar question So if I'm a victim and this the perpetrator is now in the mental health system And I call up and say has someone so been released from Treatment in my life to know that at this point. Yes, I believe not But I actually would ask uh Jack McCuller When he comes up So then the other the other question is it's kind of refreshing because you're agreeing with um the prosecutor Uh About the need for additional facilities for treatment and and we do work very closely I think we have a couple reports coming in from our um that will include Information from our designated agencies in our community service needs But what we really need to know is what level of treatment is required within the doc itself Because when I hear things like Seriously functionally impaired, I don't know what that means. Oh, that's a different I understand that It's the total difference to get services within doc We have a lot more to talk about Can you talk about that other time? Yes, we can Yes Anyway, I would thank you Both of you, thank you very much for being here The next witness is uh Serious for a commissioner department mental health I wonder if a commissioner to chef wants to come up because a lot of the questions may be for the two departments And uh, if I could jump camp before the leaves I have a message for you Yeah I'm happy Appreciate this But I think the questions really do relate to those departments Great, thank you. Uh, well, thank you for the opportunity to speak today Serious coral commissioner of the department of health and everyone who interviews themselves in the library I'd like to show commissioner for rations morning thoughts deputy commissioner Any remission no addictions mental health systems director Yes So we provided some written testimony that I hope will be helpful for you as you grapple with some of these opportunities and challenges that we face as a system We're going to talk a little bit about the role and authority of the department of mental health The federal regulations that we must comply with To ensure our Medicaid funding Talk a little bit about discharge decision making and transitions to lower the levels of care And what we as the department of mental health See as potential opportunities And solutions as we go forward and that will be told and happy to answer any questions that you all might have So I think first and foremost And I appreciate those that have testified before us have really underscored the need for partnership and collaboration We see our community justice system department for corrections as key partners in this work And the department of mental health It's important to note. We are a health care provider and payer of health care services And I visit our purview and what we are responsible for Is to provide mental health services and treatment To those in our care and to provide that care in the least restrictive settings And I think these current activities in the conversation that we're having You know really highlights the intersection of criminal justice and mental health is very very complex And when we think about public safety, of course, it's something that fundamentally we value As a department, but the tools that we have Within our capacity as a health care provider are very limited when it comes to ensuring public safety Another piece that I want to just note is that we're all aware that tropical storm Irene in 2011 And a center for destruction from state hospital Prompted the legislature to really create a new vision for our remote mental health system of care One of the core tenets of that system as articulated in act 79 Is that individuals should receive that care in the least restrictive setting And every day that I've driven to work I see the old smokestacks from the romant state hospital and reminded of our old system Where we had a decertified state hospital that did not receive Medicaid funding And people were institutionalized for long periods of time That is not the current system that we're in today And that is a good thing for the owners It's also important to note that the department of mental health we have to comply With state and federal regulations in order to provide mental health services and to maintain federal funding So our remote psychiatric care hospital currently is a state-of-the-art acute care hospital Designed to treat and assess and provide mental health treatment To those who are experiencing a mental health crisis So for any patients that are accessing care at the brought psychiatric care hospital given that is designed to Treat in terms of acuity Even for those who are criminally court involved. It's not a question of if They're going to return to the community. It's really a question of when And so any expectation or assertion that we can house individuals indefinitely in our mental health facilities or programs given the Medicaid funding that we utilize Would run counter to the charge that we take very seriously Which is to serve people in the least restrictive settings and would essentially put all of our federal funding at risk So one of the things that we think about is that one patients are stabilized Within whether it's vpch or one of our stated level one hospitals that probably retreat for Rutland Regional Medical Center And there's a very stabilized and there's at least a less restricted setting that's appropriate to their need They no longer meet acute care criteria We are required to start thinking about transitioning them to a lower level of care Um, we risk all federal funding as a state We don't comply with this regulation And we've had a lot of questions about Discharged decision-making, you know as we look to you know discharge from a hospital An acute level of care and I think what is important to note Is that it is always the unique mental health treatment needs of each individual that drive what treatment they receive Where they receive it and how long they receive it for So discharge from a hospital is a clinical decision based on that No, no longer needing hospital level care criteria And I think it was referenced earlier that there might be some time frames related to the retreat and how long they can Have folks those time frames don't exist. It's based on clinical mental health And once an individual no longer needs that mental health treatment or doesn't need that acute level of care We that work to transition them to a lower level of care It's also important to remember that when we talk about discharging someone from the acute care hospital They can still remain under the care and custody of the commissioner of mental health Through an order of non hospitalization What we've talked about It's important to note that an order of non hospitalization Is related to addressing The issues related to your mental illness. So when we're looking at risk when we're looking at dangerousness to self or others It relates directly back To your mental illness An order of non hospitalization is really to encourage and facilitate compliance with your mental health treatment Whether that's in a community residence statistically secure residential programming that we have One of our intensive residential settings a staff secure residential setting or in the community So as a tool to ensure compliance related to your mental health treatment It's not a great tool to ensure public safety In terms of assessing risk Another thing I think it's important that we step back and consider Is that mental health treatment cannot mitigate all risk? so Mental health treatment cannot address underlying criminogenic Anti-social behaviors. Those are dynamic factors that are best Managed by other kinds of programming and examples of this include substance use impulse control anger management issues history of behavior Including domestic violence So when we think about an order of non hospitalization when we think about acute levels of treatment And when we're evaluating dangerousness of self to others, we're looking at in the context of your mental illness We can provide incredible treatment to your acute mental illness. You could still be a danger Due to other reasons And then there's been a lot of conversations about public health information And I appreciate mr. Cacow kind of underscoring That the department of mental health as a health care provider and payer We have to adhere to laws That govern protected health information So as such Because we have patients in our care as a health care provider We're prohibited from disclosing information about patients So we can't even confirm or deny That someone is in our custody And that's HIPAA protective information And it's my understanding that Vermont law cannot override federal law So that's something that we need to think thoughtfully about is we think about this challenge of Notification and recognizing that we are operating under federal protected health information Then there is no general HIPAA exemption that would allow the department of mental health to notify people in the event of discharge from custody Or a change in their treatment plan, you know, that's all in your notes. You'll see that I've kind of underscored What protected health information is by definition And that includes diagnoses treatment information medical test results prescription information And would certainly apply to discharge status Can I ask a little quick question? So even if it is court order for the individual through They're still can't Well, there is an initial court order The only thing I would say is that within the initial 90 day court order, so if someone is coming Into our system Charge with the crime they need to be screened for competency or insanity There's that 90 day initial court order that isn't within the court. If we were to discharge There is a discharge here in the choir Within that first 90 days, is that correct? Yeah, there can be. But that first 90 day order Frequently often not always, but we'll have a discharge notice during requirement Or at least a notification requirement And so we provide those during that initial part, but once it goes into those subsequent hearings, it's a family court That's one of the notifications So it's a great question and it's my understanding that Vermont law can Be more restrictive than federal law, but we can't be less restrictive than federal law So that's just something else that we'll have to consider And then when we think about the opportunities or the crack of opportunity That this discussion has brought I think it really is a time We've heard some suggestions where we can come together And think about an opportunity for Vermont to have more of a true forensic system of care And psychiatric care for those who are in various stages of the criminal justice system is commonly called forensic care And one might say that Vermont is a little bit of an outlier nationally in regards to not having a forensic system of care Other states have some examples of that Which do articulate more partnership Between their respective department of mental health, the criminal justice system And corrections Some of those systems often include competency restoration programs more formally. There is also an example That Connecticut instituted the Connecticut psychiatric security review board So they essentially established an administrative psychiatric security review board to monitor the post verdict disposition of defendants Found that guilty by reason of insanity. This was prompted by public concern and procedures for follow-up of insanity complaints So other states have grappled with this have come up with potential Solutions Very well affecting resources from the critical problem Yes, I would assume so We would have to research that more And that board is comprised of appointees by the government that have expertise in law probation and parole psychology psychiatry Victim services and someone who's there to represent the interests of the general public So I put these out here as as opportunities. There have also been some suggestions that Would lead to thinking about From dual custody If you're really thinking about the limitations of our mental health system as health care providers wanting more information That's going to be enormously challenging for us And that federal requirement won't change Could you think about you know dual custody with involved corrections possibly these are all ideas I think that we can be thinking about As a system, but of course would require much more robust research And discussion and I think that Connecticut did find in the research that I did on looking at their program That the regular review of the equity progress and intensive community supervision They feel have resulted in a high level Of accountability So I do think there's an opportunity for a robust policy discussion right now. I think the department of mental health is willing To be a leader and convening partners to think about that discussion across sectors To kind of review existing models of the funds existed about care And to make recommendations about what Vermont could potentially think you think about Implementing and I do think we can use this opportunity to kind of move forward with positive change for Vermont One thing that I've learned in my work is this kind of systems change Systems change because of the speed of trust and you all can't legislate trust That's up to us systems partners to really commit to work together On this Yeah, a couple things I want to mention One is that the Department of Corrections much like Department of Mental Health or the other health institution providing direct care for an individual that's under the same Uh, rules that are in regards to protective health information So in the corrections case, we have let's say we have an individual who is requiring Either a mental health officer to care outside of the correction facility We who will notify the victim That the person hasn't moved out of the facility but we can specifically say Why they have left and where they're going It's important also to know that the Department of Corrections does not notify every victim What we do is an opt-in or opt-out situation In addition says I don't wish to know about any movement or any further actual in this case Then you will respect that decision and we don't make notifications and I think it's important distinction That the committee needs to be aware of The same rules however applied for the for any medical Treatment that's provided to a person who is in the Department of Corrections custody as they would in any other Treatment provided health care treatment provider Whether it be in the state or in the community And so I think those were some of our challenges are we we are big and navigate service struggle them We have to have a conversation with the victim who wants to be notified And the person that's going out to get care It's a difficult those are difficult and tricky waters to navigate to try and Give the victim peace of mind that the person is still in custody that they're safe and secure but we can't specifically give them instruction Or information about what's happening with the case and so there's some anxiety goes along without symptoms And our victims advocate through a tremendous job of doing of working with the victims to Help them navigate through that You want to go back to something that the attorney general mentioned about Pervasiveness of mental health in the judicial system is absolutely right And in our own system About 60 percent of the person that are care are receiving some form of mental health treatment Um, it would be very clear though. That's not a huge mental health treatment That's a very small that's much smaller percentage of people who are Um, acutely mentally ill actively mentally ill Um, in many cases the person may be uh may have a long history of depression But it's being managed and part of that management is through routine contact with mental health providers And those are captured and there are numbers of that 60 percent And in some of the in many of these cases the while they may have been an existing or persistent mental health issue Um, it's not always a good indicator that it was in any way associated with the criminal act itself And I think that's what we see from our population even in institutional behavior and part of our Our process Now is to evaluate a person who has a mental illness Is their mental illness Contribute towards the behavior that we saw from an institutional I'll talk about a couple of behavior, talking about the institutional behavior And that is back to then to how we would manage that behavior too Uh, but it's not often quite frankly that uh That a person's mental health is overwhelmingly The cause of the behavior from at least from our perspective institutional One of your statements that arose from the Berlin situation that I think The public may have taken And maybe I'm not understanding the two On page three of your testimony the purpose of an inpatient unit is not to assure a public safety Then you say it's important to remember that if someone to be involuntary and testing the inmates for their danger to self-brothers Must be resolved to dangers of mental illness I'm not sure what those things mean and then How they relate to each other so If somebody is a danger themselves or others But it's not because of mental illness They're at least Even though there's still a danger of themselves or others Well, I think what uh, what and it's not your role to protect public safety. I guess there's a confusion there On my part, I think as I read some of the public comments to the To the story and the media So we see our role In treating Providing clinical treatment healthcare treatment to someone who has an acute mental illness We see that as our role we recognize That there may be aspects of their mental illness that have caused them Or related to Dangerous action activities that are dangerous. I mean we see our responsibility To treat that mental illness Which essentially you could say Is An effort to ensure public safety, but that's not how we're thinking about it. We're thinking about it from a treatment perspective One thing that's important to remember that when we think about an acute care facility There's acuity to mental illness that we're evaluating from a treatment perspective So you may have Committed a crime Related to your mental illness. We have advanced significantly in our mental health treatment overall as a nation as a state We can treat that acute mental illness And stabilize you And at that point related to kind of our act 79 Our rules and regulations for the centers for medicated medicated services at that point We really need to be thinking about lower levels of care And that would be potentially discharging from a very restrictive acute care hospital To a step down program such as a secure Visibly secure residential program an intensive residential program Perhaps a staff secure residential program or the array of services that we have available If there is a parliament of important safety, right, I mean I I'm having a hard time understanding what's So when we are evaluating the person has a fixation on killing his mother and you know You're keeping these in a facility because he has that Goal in mind You wouldn't release him We are evaluating dangerousness to self or others related Yes, and I think the the point that I think the commissioner is trying to make is that If the assessment is someone someone's fixation on their mother as your example senator That fixation is being driven by a delusional thought process Then our thinking is geez there might be some danger here this person may need to remain in the hospital And so the end result is some public safety, but that's not that's not how we're looking at as a treatment perspective If there's If the if the assessment is that their risk is not due to the mental illness Let's say due to a head injury due to developmental disability due to other factors You know antisocial behaviors and other things of that sort Then we start seeing your premiums any behaviors or other things of that sort Then we have to look at well a hospital is not the appropriate place for that person And we are not in a in the capacity to be able to Hold them for any period of time Because then that that's again back to putting a risk of all of our That's a really great question. Are they competent to stand trial at that point? Well, they might have been competent We can talk about all these kind of different kind of permutations Yeah, I can see People not The crime isn't necessarily the crime that brought them to the attention of the authorities is not necessarily the danger I reckon it was when I ran a group home for a building in kitchen. I had a pillow And the pillow had a little hole in it And we didn't fix the little hole and all of a sudden the pillow was no longer of any use because the hole became huge as they expect at it You know, that's we don't deal with the little stuff. The big stuff will get you And I guess that's what my concerns here That's one concern another question. I know we're limited on time, but I'm confused. We were given this chart and hopefully it's correct So if the screen this is where the court ordered the psychiatric examination based on the screener's recommendation This is from legislative counsel. Okay, this is for the senator Right. Okay. Oh, great. Thank you. The screen defines the defendants for the improvements and evaluation of designated hospital 30 days psychiatric evaluation With the court If the screen defines the defendants not a person who needs treatment Then the evaluations at an outpatient facility if the defendant is released on convenience Or evaluation of correctional facility. And I guess my question is The person was found not need to treatment. They go to a correctional facility Where they're held Possibly for a lengthy period of time because they don't need treatment But if they need treatment, they don't need inpatient treatments. They don't need inpatient treatment Important. I'm very How did we set up this kind of a conundrum where? That that's confusing to me is that we we actually set that up So the guy that doesn't need treatment goes to jail And it's held in jail for whatever period of time it gets to get the evaluation done Which I'm sure is not easy to get enough psychiatric evaluation. I know I don't know I mean how hard it is to stay in jail. Is this contributing to your detention population? Overall, it's a very small percentage quite frankly. I think there are cases that That could come in I think and as I briefly discussed it takes lots for ourselves about two weeks ago Where there is The core has Evaluation and has determined that there's further evaluations required about the department of mental health to determine What if any level of treatment to the department of mental health is appropriate In some cases, this is what we see in this chart here is if they have now been evaluated by the department of mental health And they don't need The level of treatment that's provided to the department of mental health. Yes, they would come back to us Now that you want to receive mental health treatment with the department of corrections What they won't receive is hospital water care and treatment Because what happens there's they haven't been found guilty, right? Well, if you're not needed treatment you go to a jail if you're needing treatment you go to that doesn't make sense Sorry, maybe I'm missing something if they don't meet hospital This is an evaluation for hospital level treatment And so the hospital Psychiatrists determine that they don't need that level of treatment Well, I bet you've been from Dorset for a long time. I'm using my own district I'm Dorset. I probably go to my hospital. I'm from Bennington. I probably go to the hospital for jail I don't understand I'm not very nice. I'm a psychiatrist. I'm going to get me out for the time I don't know It's not a Dorset When you don't take a psychiatrist I wasn't here for this morning, but I'll do it quick You run down someone comes into court State's attorney, public defender, judge, court clerk, someone has concern about someone's mental health in the court system They have to call a dismaying agency to have a screener come in And basically if a screener is not ready within two hours, they can make their own determination But basically screener comes in and they will make an assessment and recommendation to the court should this evaluation for competency or sanity occur in an inpatient setting or in an outpatient setting At that point if the order if the recommendation is inpatient judge orders inpatient evaluation And then they will be transferred And from there they're assessed by a psychiatrist to determine to make a second determination Does this person actually need hospital level of care? The screener made that first recommendation. They're a qualified mental health professional But they're not a psychiatrist And so now the psychiatrist will make a second determination and go yes This person does need to be in the hospital and thus They're admitted to a hospital or no in fact they do not need hospital level of care And then at that point if there is still bail they will be returned to corrections if there is not bail They will be released into the community where they will have their evaluation done And they'll be released on it and club once they're released into the community. They're not in our custody They're they're out they're on their their little cognizance and they will be you know receiving their outpatient evaluation And that's a 30 day period within that 30 day period that has to happen if it's determined that they do need treatment I'm not sure about this I think the 30 days is really inpatient and we're talking about The inpatient evaluation once they're in the hospital the forensic evaluation has to happen So I have a question if there is if the screener determines the person's in need of treatment And it needs to be evaluated at the destiny of the hospital the doesn't name hospital to is the state hospital state hospital The Disney hospitals are a university of wrong medical center, but the regional medical center Wyndham center springfield probably retreat must like So what if there isn't a bed available where they go Generally the the practice is and it has been for Several years because of that availability is that The initial placement for a person when the judge has ordered inpatient evaluation is that that they would go If there is bail set, they would go to corrections or there would be Let annie or might just just discuss the delay in the person's process And if there's no bail Then that person would go to emergency room where they would have a psychiatrist see them to make that determination of hospital level here So this was part of the x 78 analysis resulted in The direction that you provided us to develop an mou between our partners here and then also to develop procedures to address This group of people who are unofficially known as the delayed placement persons dpp's And also to streamline and actually codify operationalize title 13 and title 18 requirements between all of us the people seeking hospital level of care Voluntarily or involuntarily and this is also the piece of legislation in which you directed us to develop mental Healthy units inside of the department of corrections that even though in the language of the law was forensic mental health units We came together to collectively understand that that was not the formal sense of the word of forensic mental health Unit like it might be in Massachusetts or Connecticut because that's an external forensic secure hospital And you appropriated six hundred thousand dollars Which clearly is not going to do that and that instead resulted in a department of corrections having an internal Higher level of care all the way to where somebody might be in hospital And that was enacted on July 1 of this year So we now have mental health units into the facilities and we included some information on that mo you at the request I really want to thank the four of you Helping to clear this all Clear it's not It's Again, I think that we recognize that there's different terminology Yes There's forensic and then there's forensic Some of the questions For the standing committee should we should we look at Something like should we look at Um Should we look at our real Those are some of the questions I think we have to ask Skills that last year you had a 12th bed facility forensic unit plan for The house Yeah I don't want to lose a point that sarah george raised which was also around folks who have traumatic brain injuries It was in the life school disabilities Yeah, that's a different department that we ought to bring you to the conversation Corrections is being asked to be all And anytime you asked it department But anytime you ask a department that's based upon Corrections models model to deal with offenders To be all things to all people you get the results that we're getting And I just know that I think our corrections department Does an exceptional job trying to deal With all of these problems, but they're being asked to be the institutional access work When there's nothing left for those with Developmental disabilities those with significant mental illness And the communities got up to here with certain individuals and they don't know what to do with them And that's when corrections is asked to step in In the midst of a serious opiate crisis Substance abuse and all that so With no reflection on departmental health, but I just think commissioner, you know, you've done a tough job of staying government in my opinion You're being asked to be all such odd people Well, thank you Thank you It serves me so I think you're right Yeah, I've been in this department for 29 years and in the population The acuity that the challenges of this population have changed so in market What's encouraging though is their staff have changed during along with that to the to the extent that they can Yeah Part of my vacation was more kind of evaluating and looking at other systems and how successful they've been And the european model in the norway system are really focused on Less about what I think both they call Static security which is breaking more of cameras the way that facilities laid out in procedures I know where you are and you're doing what you're supposed to be doing About dynamic security, which is all of the static factors, but it's really about human being And it's an interesting model to to evaluate In many ways from what has already moved towards that as far as the interaction But they've taken a lot of you know a significant step further where you know, they're essentially social workers And I think just one last point I think attorney general and general donovan made a really good point that we are focused on Smaller part of the population with a very high acuity But when I look across the system of care the mental health needs of reminders And we think about more beds, which is one answer and part of the solution But if we really want to get to what's underneath us, we have to look at the continued care And then really looking at our community mental health system And how do we support people from a more promotion and prevention aspect? Which is where we are seeing, you know enormous needs in our communities So we want to ensure that we have the right capacity To treat and support the highest acuity We also want to ensure that we're also focusing on the community mental health and serving people in the community to the best of our ability Thank you very much Thank you very much for the questions and for the day, Jack Tullock He deals with this Probably keeping him in his mind That's okay, this is very important too Good afternoon, I'm Jack Tullock I'm an attorney at the Law League of Law And I was working on a mental health law project Which I've been doing for about 25 years Of course I love what I wrote up to say But hopefully it answers his questions The mental health law project represents people in All the people in voluntary mental cases In the health cases all across the state Inpatient commitments, outpatient commitments In voluntary medication cases The one set of cases that we do not do Are the hospitalization hearings In the criminal division of the superior court And we'll talk about that in a little bit later But all the people that we're talking about today Are people that we are either representing Or we are likely to represent The people who are the subject of Criminal charges And are you either found by the court To be incompetent to stand trial Or found by the court to be insane In the time of the alleged offense If they then go from there To the involuntary mental health system We don't handle the initial hospitalization hearing But any subsequent hearings such as Application for involuntary medication Because the person is not taking prescribed medication Or a request to extend the order of hospitalization Not hospitalization before the initial 90 days We are planning to represent people in all of those cases Possibly the most important thing I can say At the outset is that a criminal defendant Who has been found incompetent to stand trial Or a criminal defendant who has been found Insane at the time of the alleged offense Is an innocent person It's a person who is Entitled by the constitution To the presumption of innocence And they're entitled to be Considered by our law, by our system By all our institutions To be an innocent person They've not been convicted of a crime Nothing that the courts do Or the government does to these people Or with these people Can be based on a desire to punish them For what they have done or alleged to have done Or to deter them from future criminal conduct I know that when we get very widely publicized cases Typically a dramatic and violent crime There tends to be a public upcry Or outcry about these things And there's a natural desire to say Well, we have to do something to this person Because to look at this terrible thing they have done And I think that's clearly going about Looking at this in the wrong direction Even when we think about the proposal The question of how long the person is going to be in State custody Proportionality of the detention and the alleged offense Is not an issue in the involuntary mental health system The involuntary mental health system Really addresses two questions What are the treatment needs of the patient And equally what is necessary to keep the person And public safe As you've heard, if the criminal charge is dismissed The initial order of hospitalization Can be for a period of 90 days Can be either an order of hospitalization Or an order of non-hospitalization And most of the cases We've got a lot of people in these situations Where they've been charged with a crime And they wind up in our case load But most of the cases you all never hear about Because the charge is disorderly conduct Because they're in nuisance on Church Street Or unlawful trespass Because they wandered into someone's house And they didn't belong there Most of those things the public hasn't heard about Because the person does not pose a severe long-term Danger to public safety In these cases The person, before the end of the 90 day period The Department of Mental Health Can file an application for continued treatment And in the Family Division of the Superior Court We are appointed to represent the person And the court evaluates the question of whether The person is a patient in need of further treatment And I don't know if that was part of one of the handouts It probably was But the two problems of the person The patient in need of further treatment are One, someone who's personally in need of treatment Which means they're mentally ill And both are present danger to themselves or others Right now Or someone who's receiving adequate treatment So they're not dangerous right away But if treatment were discontinued in the near future Or if treatment were discontinued They would become in danger to themselves Or others in the near future So the treatment team at the hospital The Department of Mental Health And of course the court Is always looking at not just what treatment Does a person need But what treatment does a person need And in what setting In order to prevent that person From being in danger to the public And those cases There's no time limit to those cases The person in a case such as this Is potentially subject to detention And custody by the state of Vermont For much longer than any possible criminal sentence They would have had If they'd been tried and convicted of the crime They could go on forever And we have I can tell you the courts And the Department of Mental Health Take the public safety question Very very seriously I represent people who've been committed Based on events 10, 20, even 30 years ago And they continue to be held In the custody of the Department of Mental Health Possibly inpatient Possibly outpatient Under very strict conditions Even though they want to be released We have clients who come every year When their case comes up They really want to give up their order And they ask me, well How much is enough? When do I, when do I Done my time or go to my death in society And the answer I have to give them is The time is not a factor As long as the state believes And can prove to the judge That we are a potential major We're going to be doing this every year We're representing them And doing what we can to To achieve their freedom But many of those people It doesn't matter They'll be held as long as they're Determined to have mental illness And attention for a danger To you and yourselves or others So when the suggestion was made That the determination of whether to extend In order of non-hospitalization Is based solely on the interests of the patient That is absolutely not true Another thing that is worth pointing out Because these cases come back Year after year in court It's not true that these cases Are always confidential The Supreme Court decided a case years ago Called state versus court And the question was The newspapers wanted to get into A mental health hearing to see What's going on because it was A very dramatic and violent event And the trial court said no And the Supreme Court said That there's a public interest In knowing that the department of mental health Is adequately protecting public safety And they're doing things right And so probably all of you on this committee Have actually seen news stories on TV Where you've seen me in court Probably the back of my head somewhere Where one of my clients has been In an application for continued treatment hearing And the news reporters on the TV I kind of have been there because It was determined that the public interest Militated in favor of allowing that publicity I think one of the interests From the victim's point of view Would be to know when somebody's being released From a DMH or whatever category Of order that there is And that doesn't seem to be available I agree with that I think that I agree with Commissioner Squirtle That the law does not allow for that And whatever actions we'll take In the long list, we should start to see How the federal law would allow that To be done But if we could adopt the Connecticut model, I would assume That that's passed a better law I'm not familiar with that I'll look at it I'll just turn it back on today A couple of questions I kept running a list of questions I was listening this morning The first question was Who does the forensic evaluations? It's the state contracts With a list of psychiatrists Who have private practice Around the state Who do these forensic evaluations There are four of them None of them are solid in my bill Which is a problem If we had to We would love to have people In the southern part of the state Because that way we wouldn't In my case too We would have to pay a psychiatrist To try from Burlington or Waterbury All the way down to Rutland or Stratover and the CNR We can bet it We can bet it We do send people down to that And it's a whole day Did you say psychiatrists or psychologists? Psychiatrists We have a hard time Having 40 hours a week And we can find psychiatrists In Benedictine County Let alone for evaluation Another question was Who are the screeners in Every county is sort of By one of the designated agencies And community metadol centers The screeners Who are called out to the The same people That are referred to as crisis clinicians Who are involved in Doing the emergency civil evaluations To decide if the person needs Hospitalization criteria And how do we get to this point Where someone is making this determination Before the person gets sent to the hospital Because the legislature decided years ago That there are too many people Being sent to psychiatric hospitals Or forensic evaluations Who really didn't need to be in hospital And so rightly The legislature said We're going to have some evaluation done Before the person is ordered To be hospitalized I think that was the right decision Because it's a big deal For a person to be hospitalized And it's expensive for the state To pay for them to be hospitalized So that's why we are All over the world now I think I'll stop there And see if you have any questions About the prevention disorder Of thought, mood, perception, orientation Or memory And so there could be some things That you and I might say, well Some really has a mental problem But they may not be Unmental illness Pursuant to the monstarchy PTSD Can be a tricky one The same thing With either borderline personality Or we just don't have any social personality Traumatic brain injury Traumatic brain injury You can actually have a Substantial disorder of thought Or memory as a result of Traumatic brain injury Or perception And so even though It comes from TBI You still might be diagnosed In seven or eight months Well, I don't know Where to Where to end But I know where to begin


When we look at Ubuntu for Android, we find that there are a couple of solutions already available in the market, most notably being Motorola's web top OS. So how different is Ubuntu for Android from those solutions? Sure, so the the web top service that was been launched I think maybe one or at least a year ago with the Motorola, it's based on a similar kind of capability where the phone is docked but the desktop is very very basic so essentially what you would get by docking that phone, the service that would be invoked is it's basically just a browsing capability. With the Ubuntu for Android solution what is being made available by docking the phone and to a desktop display is an entire operating system, PC operating system and it's exact and based on exactly the same operating system that is currently shipped on the many millions of laptop hardware devices. So what you're getting is a full operational PC system with the Ubuntu for Android service versus with the the the web top service from the Motorola was a very basic UI allowing you to just browse the internet. So a big difference in terms of the level of capability. Also we think that the the ability for what we're trying to discuss with handset manufacturers with the Ubuntu for Android service is that by incorporating a full desktop capability alongside with a very efficient smartphone capability you actually have a much better basis to sell phones as a productivity tool to high-end enterprise users because they are getting the full range of applications that they would be used to using on a normal desktop. What kind of market do you see for Ubuntu for Android especially in the enterprise segment? I think many enterprises will look at this particular solution and look at its advantages in terms of offering particular business users that are very very mobile that would want very easy access to enterprise applications. So the flexibility and also in terms of cost because there is less cost associated with the solution in terms of comparing it to an expensive laptop for example. So looking at the advantage of this solution there is better flexibility in terms of pure mobility. There is there is a certain cost advantages for enterprises as well and it's a very straightforward solution. So the Ubuntu desktop is currently deployed in very many enterprises. It's very well regarded as being a desktop computing system for enterprises which means that it's very well understood by IT management. It has very high levels of security so in many ways it actually doesn't detract too far from how enterprise IT managers for example would want to manage that. It's basically the same systems that are being deployed but available simply in a smartphone context rather than a laptop context. How is this going to work? Will there be Ubuntu for Android available on the internet which people can just download and install on their smartphones or are you working with the smartphone manufacturers and Ubuntu for Android will come pre-installed on the phones? Okay so the prototype has been developed for us to engage directly with handset manufacturers so there are a number of integration points that are very specific around user experience and hardware performance which means that the most effective way in which the solution can be enabled within a smartphone hardware is by working directly with handset manufacturers which means it's integrated a source and shipped as part of the smartphone. At this stage it's not something that's available to download and install on different types of hardware simply because there are very specific hardware requirements which would mean it would be too difficult for a user to install and expect to run the service as well as if it were integrated a source by the handset manufacturer. If an OEM decides to put Ubuntu for Android on their smartphones is it going to increase the cost of the phone and what kind of market will there be for these kind of smartphones? Well we think that there is demand for high-end smartphones so particularly from enterprise users people we see the flexibility in having full mobility of carrying a PC operating system within the particular smartphone so in terms of justifying what we believe the demand for this solution will be. At the moment there are a lot of high-end smartphones being manufactured right now. The solution that we offer is a solution that can be integrated without affecting the base cost of the current smartphone that are being developed so we're not impacting the price of the smartphone any way at all in terms of the cost of what it takes to develop that smartphone but what we are doing is improving the ability for the handset manufacturers to sell more of those smartphones and generate a higher margin from those smartphones. The solution by itself because it's going to be embedded within a very high-end particular phones these phones are being developed so there is a demand for those phones already these phones will go into the enterprise market it's just that we believe that we're now in a position where we can add further functionality to those phones that are already being they're already about to be shipped by having this particular solution available as well. If you look at Ubuntu for Android from mobility point of view which means that I need an HDMI monitor I need an HDMI cable then keyboard and mouse it will be far more easier for me to just carry my laptop and then I won't have to worry about finding a monitor at an airport what do you see about that? Yeah I mean that is a dependency in terms of having full access to and the desktop solution so you do need access to a display over HDMI and a cradle that's something which you know we believe handset manufacturers will start to address because the demand for this particular solution will mean that the peripherals will be available at the same time so as this particular hardware with this solution goes to market handset manufacturers will also be looking at making certain peripherals available such as keyboards and docking cradles and those those types of items. I think that you know to expect this particular solution to entirely replace every single context where it's useful to use a laptop is probably you know not the right way in which we would choose to go choose the messaging for this particular product to work but that aside we believe that there is a high level of functionality and flexibility in terms of the portability of the system that we've got and that will be very attractive to a to a high number of business users. Can you give us some use cases or scenarios where Ubuntu for Android makes sense for enterprise customers or individuals? There are quite a few different scenarios where we think this might be relevant and we've been having conversations with different people here this week actually who have come to us and said this is a really great idea for our enterprise so we think high-tech industries for example high-tech companies are very very interested in using this kind of solution so there are I think it depends on the particular company itself and what level of mobility that they want to they want to have available to to their enterprise workforce. I think it also boils down to the some individuals some individuals tend to be very very mobile and and we'll see this as being a very very attractive solution for them. It's it's difficult to give you a full range of particular sort of tried and tested markets that we believe are relevant but we think they are they exist and that's justified by a lot of the conversations that would be taking place this week particularly as I said with technology companies I also think given you know that we announced the service last week we received tremendous press attention overwhelmingly positive which kind of justifies the fact that there is a lot of enthusiasm about this product in the market and we believe that will translate into a high level of demand as well. I totally agree that there's a lot of excitement around Ubuntu for Android people are excited about it but can you give us some examples where Ubuntu for Android offers the solutions to the problems that enterprise customers face or can you give us some some use cases. I think perhaps one example is a an executive for example it can be it can be regarded as being very relevant in terms of an executive context so this is this is a phone that allows an executive to have access to their applications both that both their cloud-based services both their desktop services personal content as well as having you know obviously a highly efficient mobile phone as well so it's I don't think that it's I think the more relevant contexts are with individuals that have a very highly mobile nature about the way that they go about their work so you know sort of senior managers for example people that want the kind of flexibility that this offers. They would also be context in terms of field workforces for example so where the physical traveling weight of a additional piece of hardware is something that is you know perhaps cumbersome in their day-to-day work so there are field engineers as examples that have also been discussed here this week as something that this solution could be adapted to to work very well with. Can you tell us a bit more about how these two technologies are going to work together I mean you have one hardware and then you have a desktop OS which is Ubuntu and then you have a smartphone OS which is Android and they will be working together and they will be running on the same processor in the same hardware at the same time so can you explain how these two technologies work together. Okay so we have fundamentally we're integrating in two levels so the Linux kernel on this particular smartphone for example is obviously a Linux kernel Ubuntu is a very popular the most popular Linux desktop system so there is a capability at the Linux level that enables us to work with the kernel and establish what we've called a shared kernel architecture so the kernel is able to run both an Android phone system and the Ubuntu operating system at the same time so there's no virtualization taking place this is natively two OSes running at the same time and that's fundamentally achieved through working directly with the Linux kernel itself. As we start to work with handset manufacturers we're in a position to select the most effective kernel that's relevant to run both solutions as efficiently and as performant as possible and that's based on the fact that we have you know a kind of merging taking place between a Linux phone operating system and a Linux desktop operating system so that's the first fundamental in terms of how the technology works in terms of the services as well as having the Ubuntu desktop running as we saw fully fledged on the desktop with the same level of the same services that you would expect from a normal Ubuntu release we've also established a number of integration points with the Android applications so the Android system itself is completely independent of the Ubuntu system we haven't worked on the Android system at all we're just taking available APIs that are available from the application layer within the Android services such as the the dialer the address book the email clients the music player and many others and we're integrating them to make that those services available in a pure desktop environment so and that and the user interface that we've used our standard desktop applications so the email client I showed you is a desktop email client that has integration synchronization with the Android email client so it's those two levels of integration that that we've used to fundamentally build this build a solution one curiosity that I have is are these two systems running at the same time if yes what kind of impact it will have on the battery life or the user experience while a user is using Android and what happens when the phone is docked and then undocked when the phone is as a mobile phone it's obviously running Android Ubuntu is not running or having any impact on either the battery life or the performance of the of the smartphone so to stress again we that the solution we delivered does not impact or encroach on the Android system at all so when the phone is undocked and used as it should be a mobile phone there is nothing impacting the performance of the battery life of that phone itself if it has the Ubuntu for Android solution embedded within it when the phone docks the cradle itself is powering the phone so again battery life is not affected in terms of that particular in terms of docking to the phone obviously in a desktop experience we see a number of you can expect power to be available it's quite reasonable to expect that you know when you when you're docking a phone you will have power available to the phone so there's no no performance issues in that in that respect in addition to that as I said the when the phone's docks the phone starts to boots and run to operating systems both running concurrently independently of one another and the Android system is entirely functioning as it as it was before so all the phone services all the Android services then the phone system are still very much in operation it's just that the performance that the power of the phone is now focused on the desktop use case because it's reasonable to assume that when someone's docked the phone at the desktop what they want is a desktop experience and so that's when the Ubuntu operating system takes presence if you like in terms of access to services. I noticed some Android applications when the phone was docked so does that mean a user will be able to use Android applications while the phone is docked and you're using Ubuntu? So another element that's integrated within the services full access to Android applications so within the application lens that I showed you there was a cat it's a dedicated category purely around access to Android applications so you could use maps you could use any any any Android application that's on the phone is accessible through Ubuntu user interface that also includes applications that have been downloaded by market so you could pay Angry Birds on your desktop if that's if that's something there are different gaming contexts that are available it also means that as this service starts to become better known in the market Android developers can develop their applications for particular uses in the context of a display user interface so they can start to engineer a more richer experience in their applications because they know that a proportion of the downloads will be relevant for both a smartphone form factor as well as a desktop display so that's also something that could be encouraging in terms of the Android ecosystem. Which version of Android can run or support Ubuntu for Android is there any kind of dependency on a particular version of Android? Also we've prototyped on 2.3 which is Gingerbreads. Gingerbread is now being superseded by ice cream sandwich 4.0 so but there is there's no dependency on any particular version of Android so users can expect to see this on the very latest version of Android and that's dependent on the particular hardware manufacturer and what version they've selected to actually ship with. Is there any possibility of putting this solution on Android tablets as well? Well there's there isn't any plans to put it on tablet we have our own tablet development taking place so we will be launching a tablet fully fledged Ubuntu tablet working on its own operating system we will be launching our own mobile OS system so you can certainly expect to see this on our mobile OS once we actually once we bring that bring that to market but yes I think there could be use cases in a tablet as well that you know we would need to think through carefully. Ubuntu is gradually becoming omnipresent you have Ubuntu on desktop soon you will have Ubuntu's on your TVs, smartphones and tablets and you only have this Ubuntu for Android. What kind of integration will there be among all these Ubuntu powered devices for example if I am watching the movie on my Ubuntu TV and I have to go out and I want to watch that movie on a tablet without interruption is that possible or is it too far-fetched to think that there will be very tight integration among all these Ubuntu devices? Well that's a very challenging context to address for any technology company we are first and foremost a software organization so we work with hardware manufacturers we're currently focused on working obviously in addition to our core business around shipping Ubuntu within laptops in terms of user services we're obviously focused on smartphones we're working on tablets we're working in our own phone OS we're working on Ubuntu TV as I'm sure you heard from Will. How we marry all of those different services within one particular device is a very very challenging thing to address but what we do have in terms of advantage over other systems is that the Linux system is perhaps the most flexible and most easiest basis with which you would look to enable each of those services and support them on one device I can't think of another system that could do it anywhere as well as Linux so that would I think put us in a quite strong position to be able to work with people that want to deliver those those kind of services which we obviously we you know we want to do