The U.S. Department of Justice announced an investigation into the mental health services system within Jefferson County Tuesday.
The department wants to determine if individuals with severe mental illnesses have been unnecessarily institutionalized or had more run-ins with police as a result of a lack of accessible resources.
“When people do not receive the community-based mental health services they need, they often get caught in a cycle of psychiatric hospital stays,” Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said in the announcement.
Sheila Schuster, executive director of the Kentucky Mental Health Coalition and licensed psychologist, has advocated for mental health resource access for nearly 40 years. The coalition she directs comprises more than 80 consumer and family advocate organizations across the state.
Below are excerpts from Schuster’s conversation with Aprile Rickert of WFPL News, edited for brevity and clarity.
On “community integrated mental health resources” and what they look like:
We’re talking about having a full continuum of care for people who have mental health needs, so that they could live in the community in an integrated way. In other words, to be a part of the community and not segregated from the community so that they have the opportunities like all of us do: to access transportation, access job opportunities, access, first and foremost, I should say, to behavioral health and healthcare, and to have quality of life.
“If we’m talking about persons with serious or severe mental illness, we’re talking about individuals who have a history of significant symptoms and problems with their mental health functioning. They usually have a diagnosis of schizophrenia or schizoaffective disorder, bipolar disorder or major depressive disorder, or could be PTSD. And they, hopefully, are known to our community resources that aren’t getting the help that they need. ”
On whether or not Kentucky’s community integrated mental health resources are meeting the public’s needs:
“Sadly, they are not, and it’s not for lack of trying. The community mental health movement started with the signing of the Community Mental Health Act of 1963 by President John F. Kennedy, it was the last bill that he signed before his unfortunate assassination. And the whole idea was to empty out or deinstitutionalize these huge mental health hospitals. There were some in Kentucky that had close to 2,000 patients. Some of them had developmental intellectual disabilities, some of them had dementia, some were physically disabled, but all had ended up in a state hospital.
“The whole idea of [the community mental health] movement was to empty out the hospitals, to have the state pick up the funding that the federal government had been paying for these hospitalizations, and to create those community based services.
“Unfortunately, the funding has never been there. I do not think Kentucky has kept its commitment to fully fund the community resources that are needed. So we dropped from what I would call a number one ranking. It’s an ongoing struggle with the budget sessions to get the adequate funding for the community mental health centers and for other agencies that are called behavioral health service organizations, or BHSOs, that also can bill Medicaid and work with these very specialized populations.
On Kentucky’s ability to provide resources and how it compares to other states:
“You know, I think it varies across Kentucky. One of the things that I’m a little bit curious about is why the DOJ is focusing on Louisville. You know, I work with all of the community mental health centers across the state, and there certainly are pockets, particularly in our more rural regions of the state, where there are probably fewer resources available than we have here in Louisville. So I’m a little bit surprised. I do not know if it’s related to the investigations that are ongoing right now with DOJ looking at the jail and police actions, but certainly the suicides in the jail have been alarming and disarming in the last six months or so.
“I’m not sure we have the funding, for instance, for our mental health courts to be diversionary. What we really want to do is to divert people away from incarceration and the police system and into treatment. I know the head of Metro Council [David James] talked about a diversion program that’s just getting started here in Louisville. Those programs, unfortunately, are not as available out in smaller rural communities and out in other parts of the state.
“If you look at just funding, the other thing I would say is that NAMI, the National Alliance on Mental Illness, nationally used to do a report card of states and compare them on services for people with mental illness. They looked at outpatient and inpatient services, crisis services, and so forth. I believe at the time, six to eight years ago, Kentucky was the only state at the time that had gotten two F’s on those NAMI report cards.
“We passed legislation in 2017, called Tim’s Law, which would allow the courts to order outpatient treatment, and the person would not be under court order. It’s been extremely successful, and 40 other states have it. We’ve never gotten the funding for it. The state got a grant and has started rolling it out in a couple of areas of the state, but we do not have the funding to take it statewide.
“That’s the kind of program that you really want. You want people to have a reason, even if it’s under court order, to get the kind of treatment that they need so they can get into a recovery period and understand that they have an illness that they need to take care of it, and that they have an opportunity to have a very productive life and to be a part of the community. ”