The US Department of Justice announced an investigation into the system of mental health services in Jefferson County on Tuesday.
The department wants to determine whether individuals with severe mental illness are unnecessarily institutionalized or have had multiple conflicts with the police as a result of a lack of available resources.
“When people do not receive the mental health services they need in the community, they are often caught in a psychiatric hospital stay,” Assistant Chief Prosecutor Kristen Clark of the Justice Department’s Civil Rights Department said in a statement.
Sheila Schuster, executive director of the Kentucky Coalition for Mental Health and a licensed psychologist, has advocated for access to mental health resources for nearly 40 years. The coalition she leads consists of more than 80 consumer and family protection organizations across the country.
Below are excerpts from Schuster’s interview with Aprile Rickert of VFPL News, edited for brevity and clarity.
About “community-integrated mental health resources” and what they look like:
“We are talking about complete continuity of care for people who have mental health needs, so that they can live in the community in an integrated way. In other words, to be part of the community and not separated from the community so that they have opportunities like all of us: to have access to transportation, access to job opportunities, access, above all, I should say, behavioral health and health care and have quality of life.
“If we are talking about people with serious or severe mental illnesses, we are talking about individuals who have a history of significant symptoms and problems with the functioning of mental health. They are usually diagnosed with schizophrenia or schizoaffective disorder, bipolar disorder or major depressive disorder, or may have PTSD. And they are, hopefully, known to the resources of our community who are not getting the help they need. “
On whether Kentucky’s integrated mental health resources in the community meet the needs of the public:
“Unfortunately, they did not, and it is not due to lack of attempts. The Community Mental Health Movement began with the signing of the 1963 Community Mental Health Act by President John F. Kennedy, it was the last law he signed before his unfortunate murder. And the whole idea was to empty or deinstitutionalize these huge mental health hospitals. There were close to 2,000 patients in Kentucky. Some of them had intellectual disabilities, some had dementia, some were physically disabled, but all ended up in a state hospital.
“The whole idea of [the community mental health] the movement was to empty hospitals, to raise funds from the federal government for these hospitalizations, and to create these services in the community.
“Unfortunately, there were never any funds. I don’t think Kentucky has maintained its commitment to fully fund the community’s resources that are needed. That’s how we fell from, as I would call it, the number one ranking list. It is a constant struggle with budget sessions to obtain adequate funding for community mental health centers and other agencies called behavioral health organizations, or BHSOs, which can also charge Medicaid and work with these highly specialized populations.
On Kentucky’s ability to provide resources and how it compares to other states:
“You know, I think it’s different from Kentucky. One of the things that interests me a bit is why DOJ focuses on Louisville. You know, I work with all the community mental health centers across the state, and there are certainly pockets, especially 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 surprised. I don’t know if it is related to the ongoing investigations with the DOJ that monitors the prison and police actions, but suicides in prison have certainly been alarming and disarming in the last six months.
“I’m not sure we have the means, for example, to diversify our mental health courts. What we really want to do is dissuade people from prison and the police system for treatment. I know the head of the subway council [David James] talked about a diversion program just starting here in Louisville. Unfortunately, these programs are not so available in smaller rural areas and in other parts of the country.
“If you just look at the funding, the other thing I would say is that NAMI, the National Alliance for Mental Illness, did state reports at the national level and compared them to services for people with mental illness. They observed outpatient and hospital services, crisis services and so on. I believe that at the time, six to eight years ago, Kentucky was the only state at the time to receive two Fs on those NAMI reports.
“We have adopted a law in 2017 called the Tim’s law, which would allow the courts to order outpatient treatment, and the person would not be under a court order. It was extremely successful, and there are 40 other countries. We never got the funds for it. The state received a grant and started to apply it in several areas in the state, but we do not have the financial means to take it in the whole state.
“It’s the kind of program you really want. You want people to have a reason, even if it’s a court order, to get the kind of treatment they need so they can get into a recovery period and realize they have a disease they need to take care of, and have a chance to have a very productive life and to be part of the community. ”