Kentucky is violating residents' civil rights by "unnecessarily segregating adults with serious mental illness" in psychiatric hospitals in the Louisville area, rather than providing them with care in community settings, according to a U.S. Department of Justice investigation released Tuesday.
The investigation, which began in 2022 , found the state is violating the Americans with Disabilities Act by failing to provide access to community-based mental health services, including mobile crisis response, case management and permanent supportive housing.
“Instead, Kentucky relies unnecessarily on psychiatric hospitals in violation of the ADA,” a statement from the Justice Department said. “Each year, thousands of people are admitted to psychiatric hospitals in Louisville, and more than a thousand people experience multiple admissions to these restrictive and often traumatizing settings.”
Louisville Metro Government has also contributed to these issues, the DOJ found, due to deficiencies in the city's emergency response system. And a large swath of the community is affected by the systemic failures.
Seven Counties Services, one of 14 state-licensed Community Mental Health Centers in the state, which serves Jefferson County and the surrounding region, estimates 15,500 adults with serious mental illness live in Louisville, with the organization providing service to 6,000 annually.
The report includes a series of recommendations for reform, and the Justice Department said it looks forward to "working cooperatively with Kentucky to reach a resolution." However, the department could file a lawsuit to ensure the state is compliant with the ADA if the sides can't come to an agreement.
In an email Tuesday night, Gov. Andy Beshear spokesperson Crystal Staley said the governor's office was "surprised" by the report, as it had not been contacted by the DOJ since last September. She was critical of the investigation, arguing it did not do enough to recognize the hard work mental health care agencies in Louisville do and saying the administration "continues to prioritize Kentuckians’ mental health."
Beshear worked to expand Medicaid access and helped launch the 988 crisis hotline during time in office, she said, among other steps to improve mental health care in the state.
Kevin Trager, a spokesperson for Mayor Craig Greenberg, noted the report highlighted a pilot program that makes crisis teams available in Louisville and that has grown since it began in 2021. He added the lack of community-based mental health services is "a nationwide problem that leaves far too many individuals without critical, often lifesaving, care."
Staley added Beshear also "tried to implement crisis response teams, but they were not funded by lawmakers during the last legislative session."
The new report is separate from a wide-ranging pattern or practice investigation into the Louisville Metro Police Department, released in 2023, that found Metro Government and LMPD violated the ADA by “unnecessarily deploying police to behavioral health calls.” Louisville is in negotiations for a consent decree with the department regarding that investigation.
The lack of community-based services has caused police to be the first responders to mental health crises, which the DOJ said resulted in unnecessary incarceration, according to Tuesday's release.
“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 press release.
Key findings in the DOJ report
The 30-page report, put together by the DOJ and the U.S. Attorney's Office of the Western District of Kentucky, is the result of hundreds of interviews with state officials, mental health and social service providers, along with judges, advocates, people who have been hospitalized and others who have been in the city's psychiatric facilities.
It paints a bleak picture of how the city and its health care providers often respond when people are experiencing a mental crisis. Key issues repeated throughout the report include:
- A system that puts too many people in psychiatric hospitals instead of providing services in the community (about 7,400 adults were admitted to Central State Hospital or had a psychiatric inpatient admission in Louisville in fiscal years 20221 and 2022, with more than 2,300 people returning more than once);
- Repeated extended stints in psychiatrics hospitals without appropriate care, leading to the loss of living skills and failures to communicate when a person is scheduled to leave a hospital;
- A lack of transport for services and a lack of access to services when a patient is discharged from a hospital;
- Involvement by police and law enforcement officials when more flexible community-based services could help, which leads to people suffering from serious mental illness getting unnecessarily caught up in the legal system;
- "Insufficient" coordination between hospitals and community providers to establish individualized care plans for residents discharged from hospitals;
- And an inpatient system that isolates people from the community for extended time periods.
The lack of sufficient community-based services ends up putting more people dealing with serious mental health issues in facilities such as Central State Hospital, a 120-bed psychiatric facility in La Grange, and University of Louisville Hospitals' Emergency Psychiatric Services wing, an emergency room that takes in about 2,250 adults each year (many with multiple visits).
"(F)or many individuals in Louisville today, police officers, EPS and hospitals are the primary options for help," the report reads. "And without a connection to long-term services, many simply reappear at EPS the next time a crisis occurs."
In a Wednesday statement, U of L Health said it "recognizes the need for more community-based resources in Louisville and across the Commonwealth to assist with the care of this population."
"We stand ready to partner with all groups interested in helping," an email from spokesperson Heather Fountaine said.
In a separate statement, Seven Counties said it is "closely analyzing" the new report, noting the organization has taken part in two community health surveys this year, with one resulting in a new behavioral health coalition in the county to encourage collaboration between local partners.
"As a community and organization, Seven Counties Services remains fully dedicated to providing quality care and health services to improve the lives of individuals and families," the statement said. "Providing community-based services and access to care for all individuals in our community including those with (serious mental illness) and/or those in crisis is at the heart of our mission."
Neither U of L Health and Seven Counties granted interview requests.
The report was critical of the system's reliance on police to serve as first responders to behavioral health crises, which often leads to "avoidable arrests."
Like its 2023 report on LMPD, Tuesday’s investigation highlighted the case of a man with an “apparent serious mental illness” who was arrested by LMPD 18 times between March 2020 and January 2022. He died at Metro Corrections in January 2022 days after being arrested for refusing to leave a downtown restaurant .
Improving access to mental health resources in Louisville
In response to the report, Greenberg spokesman Trager touted Louisville's crisis diversion program, which sends mental health professionals to some behavioral health calls. That program was created after Louisville Metro Government agreed to retain social workers and dispatch them to some calls as part of a settlement over the 2020 police killing of Breonna Taylor . It was expanded to 24-hour coverage across the city last month.
The program allows non-police responders to react to qualifying behavioral health crisis emergency calls. However, calls involving weapons are not eligible for a non-police response. While the DOJ called it a "positive step," the report also said the program currently remains "insufficient to meet the need."
The report offered several recommended modifications to the system, including:
- Increasing the availability of services — many good programs exist, but they're frequently unavailable and inaccessible, and the state has not ensured development of these services in its largest city;
- Making services Medicaid reimbursable;
- Ensuring permanent affordable housing options are accessible and available;
- Improving oversight and assessment, as well as record retention;
- And avoiding hospitalizations and contact with law enforcement when possible.
Trager said local officials are well aware more action is needed. But more support is needed as well.
"We know Louisville’s health care providers and first responders are working hard to serve our most vulnerable residents," Trager said. "The Mayor looks forward to working with leaders in Frankfort to ensure that all Kentuckians facing a mental health crisis can get the care they need. But ultimately, cities like Louisville need our federal partners to help provide comprehensive resources and investments if we are to make the meaningful progress we all want."
This story may be updated.
Reach reporter Eleanor McCrary at EMcCrary@courier-journal.com or at @ellie_mccrary on X, formerly known as Twitter . Reach Josh Wood at jwood@courier-journal.com and reach Lucas Aulbach at laulbach@courier-journal.com.
This article originally appeared on Louisville Courier Journal: DOJ: Kentucky violating civil rights of adults with serious mental health illnesses
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