Kentucky could be in violation of federal law without more community-based mental health care

By Sarah Ladd

Kentucky Lantern

The U.S. Department of Justice says it has “reasonable cause” to believe Kentucky is violating the Americans with Disabilities Act in Jefferson County.

This finding comes after a two-year federal investigation “focused on whether Kentucky subjects adults with serious mental illness to unnecessary segregation in psychiatric hospitals in Louisville.”

In a 30-page report Tuesday, the Department of Justice (DOJ) found Kentucky doesn’t adequately treat Louisvillians with serious mental health issues in compliance with the Americans with Disabilities Act (ADA), enacted by Congress in 1990 to protect people with disabilities from discrimination.

Jefferson County, the report says, relies too heavily on psychiatric hospitalizations, police and detention that could be avoided with community-based mental health services, which it also does not adequately connect people with following hospitalization.

Key points in the report include:

• In 2022, 16% of people admitted to psychiatric hospitals in Louisville were also sent to jail.
• In 2022, 1,100 people were admitted more than once to a psychiatric hospital.
• More than 500 had three or more such hospital admissions.
• Thousands of others are admitted once.

“Many” people in the county spend more than a month in such hospitals, according to the report, which calls the facilities “highly restrictive, segregated settings in which people must forego many of the basic freedoms of everyday life.”

“Admission to these institutions can be traumatizing, and it can upend the lives of people who experience them. With the right community-based services, many of these hospitalizations could be prevented.”

“Because of the lack of community-based services, law enforcement officers are routine responders to mental health crises in Louisville,” the report states. “Many of these encounters could have been avoided with community-based services, and those community services could have provided an alternative to incarceration in Louisville Metro Detention Center.”

In a Tuesday letter to Gov. Andy Beshear, the DOJ outlined “unnecessary segregation, and serious risk of segregation, in psychiatric hospitals” for people in Louisville with serious mental health issues. It also warned it could file a lawsuit to force Kentucky to comply with the ADA if it cannot reach a resolution.

The Beshear administration “continues to prioritize Kentuckians’ mental health,” spokeswoman Crystal Staley said, pointing to Beshear’s emphasis on mental health Medicaid coverage and the utilization of 988 .

“We are surprised by today’s report as the cabinet has not heard from the Department of Justice since last September,” Staley said. “There are sweeping and new conclusions that must be reviewed as well as omissions of actions that have been taken. We will be fully reviewing and evaluating each conclusion.”

“To the Louisville area mental health providers, the administration recognizes your hard work and wishes today’s report had fully acknowledged all that you are doing,” Staley added.

Louisville ‘not unique’

“People with serious mental illnesses in Louisville are caught in an unacceptable cycle of repeated psychiatric hospitalizations because they cannot access community-based care,” Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said in a statement. “We thank Kentucky for its full cooperation with our investigation, including readily providing access to staff, documents, and data.”

“We also recognize that Kentucky has already begun taking important steps to expand access to a range of key services, including crisis response services ; medication management supports; and housing and employment supports,” Clarke added. “Our goal is to work collaboratively with Kentucky so that it implements the right community-based mental health services and complies with the ADA.”

Marcie Timmerman, president of Kentucky’s chapter of Mental Health of America, said one of the “largest barriers” to better access to community-based services emphasized in the report is funding.

“Louisville is not unique in Kentucky in not providing all the available service arrays,” she told the Lantern.

The legislature needs to put more money into mobile crisis units, Timmerman said, that could help people upstream — before they are experiencing mental health emergencies.

U.S. Attorney Michael A. Bennett of the Western District of Kentucky said in a statement that the findings go “beyond the violations.”

“These findings,” he said, “are also about recognizing the dignity and potential of every individual who has mental illness.”

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