Law cre­ated to help men­tally ill not used

Lexington Herald-Leader (Sunday) - - Front Page - BY JOHN CHEVES

No­body is us­ing a her­alded 2017 state law that was in­tended to help hun­dreds of Ken­tuck­ians with se­ri­ous men­tal ill­ness break the per­ilous cy­cle of home­less­ness, jail and in­vol­un­tary hos­pi­tal­iza­tion, ac­cord­ing to court of­fi­cials.

“Since it’s passed, I don’t re­call hav­ing a sin­gle Tim’s Law case,” Fayette District Judge Kim Wilkie said in a re­cent in­ter­view.

“But we’ve got to get these folks help,” Wilkie said. “We’ve got to get them treat­ment, we’ve got to get them med­i­ca­tion, we’ve got to get them off the streets or else they’re gonna get in trou­ble.”

After sev­eral years of lob­by­ing by men­tal health ad­vo­cates, the Gen­eral As­sem­bly last year over­whelm­ingly passed Tim’s Law and over­rode a veto by Gov. Matt Bevin. The law cre­ated a pe­ti­tion process so that district court judges can or­der se­ri­ously men­tally ill peo­ple, un­der cer­tain spe­cific con­di­tions, into su­per­vised out­pa­tient treat­ment, in­clud­ing med­i­ca­tion, coun­sel­ing and en­roll­ment in pub­lic as­sis­tance.

Bevin said he ve­toed Tim’s Law be­cause it would “per­mit the re­stric­tion of lib­erty for in­di­vid­u­als who have not com­mit­ted crimes and do not pose a threat to any­one.” The leg­is­la­ture dis­re­garded Bevin’s ob­jec­tions, al­though the Ken­tucky Depart­ment of Pub­lic Ad­vo­cacy warns that it will file a con­sti­tu­tional chal­lenge to Tim’s Law on be­half of peo­ple or­dered into treat­ment if the law ever is used.

“These are in­di­vid­u­als who have done noth­ing wrong. They have a men­tal ill­ness,”

the state’s pub­lic ad­vo­cate, Da­mon Pre­ston said last week. “If some­one is liv­ing their life and not both­er­ing oth­ers, they should be free to do so with­out the govern­ment telling them what to do.”

Tim’s Law is named for Tim Mor­ton, a Lex­ing­ton man who was hos­pi­tal­ized for psy­chi­atric treat­ment dozens of times over 36 years, of­ten in­vol­un­tar­ily and in po­lice hand­cuffs, be­cause he did not rec­og­nize that he had schizophre­nia.

When Mor­ton wasn’t locked in East­ern State Hos­pi­tal, he spent his days aim­lessly wan­der­ing the city streets. Un­til he clearly posed a dan­ger to him­self or oth­ers — which only hap­pened after he spi­raled down­ward for long enough — there was no le­gal mech­a­nism for his loved ones to force him into treat­ment. Mor­ton died in 2014 from long-ne­glected health prob­lems at the age of 56.

His story, while tragic, wasn’t un­com­mon. A 2006 study from the U.S. Jus­tice Depart­ment found that more than half of prison and jail in­mates were men­tally ill, as was roughly one­fourth of the homeless pop­u­la­tion. These were peo­ple who had a hard time keep­ing a job or hous­ing or un­der­stand­ing so­ci­ety’s rules, the study found.

Last year, law­mak­ers said they hoped Tim’s Law would make a dif­fer­ence for an es­ti­mated 2,000 un­treated Ken­tuck­ians who suf­fer as Mor­ton did from anosog­nosia, a fail­ure to rec­og­nize that they have se­vere men­tal ill­ness. Al­ready, 44 other states had a sim­i­lar law on the books al­low­ing for “as­sisted out­pa­tient treat­ment” in such cir­cum­stances, they said.

“I have con­fi­dence that, while this is a small step, it’s a step in the right di­rec­tion. We’re go­ing to be able to help a lot of these folks,” state Sen. Ralph Al­varado, R-Win­ches­ter, one of the bill’s spon­sors, said at the time.

How­ever, no pe­ti­tions have been filed un­der Tim’s Law so far, ac­cord­ing to a re­view of statewide data by the Ken­tucky Ad­min­is­tra­tive Of­fice of the Courts and in­ter­views with judges in Lex­ing­ton and Louisville who over­see their cities’ men­tal health courts.

Part of the prob­lem is a lack of pub­lic aware­ness, court of­fi­cials said. But the leg­is­la­ture also failed to pro­vide any money for more staff at com­mu­nity men­tal health agen­cies or court­houses, or — since re­spon­dents are en­ti­tled to a lawyer to rep­re­sent them at hear­ings — pub­lic de­fender’s of­fices. All of these state­funded in­sti­tu­tions al­ready are strug­gling with their cur­rent caseloads.

In fact, tucked into the nine-page law is a short note stat­ing that it won’t take full ef­fect un­til “ad­e­quate fund­ing” is made avail­able.

“It breaks my heart, it re­ally does,” Faye Mor­ton, Tim’s mother, said last week. “We’re very aware of the lack of in­ter­est in this.”

Ad­vo­cates who fought for the law say con­tin­ued in­ac­tion is un­ac­cept­able.

Un­less they are com­pelled to ac­cept treat­ment, Ken­tuck­ians like Tim Mor­ton of­ten find them­selves ar­rested on “nui­sance” charges such as tres­pass­ing or dis­or­derly con­duct. And a jail cell is not the right place for such peo­ple, said Kelly Gun­ning of the Na­tional Al­liance on Men­tal Ill­ness in Lex­ing­ton.

“Would you want can­cer pa­tients go­ing to jail to be treated?” Gun­ning asked. “If you have pan­cre­atic can­cer, you don’t go in hand­cuffs in the back of a pa­trol car to the jail for your treat­ment. You’re sick; you go to a doc­tor. Peo­ple who are men­tally ill are phys­i­cally sick. Their brains are bro­ken. We know this from PET scans. You don’t deal with that by lock­ing peo­ple up in the crim­i­nal jus­tice sys­tem.”

Un­der Tim’s Law, a pe­ti­tioner can swear to a district court that some­one has been di­ag­nosed with a se­ri­ous men­tal ill­ness, has been in­vol­un­tar­ily hos­pi­tal­ized at least twice in the pre­vi­ous 12 months and is un­likely to vol­un­tar­ily ad­here to the treat­ment they need to re­main healthy.

After a hear­ing and an exam, a judge can or­der the per­son into out­pa­tient treat­ment, with reg­u­lar progress re­ports to be made to the court. As a com­pro­mise to those con­cerned about civil lib­er­ties, law­mak­ers draft­ing the law made it clear that peo­ple who dis­obey an or­der for treat­ment will not face con­tempt of court charges, al­though they could be held in a hos­pi­tal for 72 hours for an eval­u­a­tion.

The real power of Tim’s Law — and in sim­i­lar laws in other states — lies in “the black robe ef­fect,” Gun­ning said. Peo­ple want to please the judges they reg­u­larly see in court by mak­ing progress with their treat­ment, even if there isn’t a crim­i­nal penalty hang­ing over their heads, she said.

Men­tal health courts do some­thing sim­i­lar, but their par­tic­i­pants have been charged with mi­nor crimes that can be di­verted through suc­cess­ful com­ple­tion of a pro­gram, while Tim’s Law re­spon­dents are not fac­ing charges.

“Ul­ti­mately, what’s go­ing to make the dif­fer­ence is know­ing that some­one cared enough to check up on me and made sure that I was do­ing what I was sup­posed to do,” Gun­ning said. “I won’t want to dis­ap­point peo­ple who are mak­ing that ef­fort for me.”

Sev­eral ad­vo­cates said Tim’s Law could be­gin on a trial ba­sis with­out much cost in ex­ist­ing men­tal health courts in Louisville and Lex­ing­ton. These pro­grams al­ready have the staff and re­sources that would be nec­es­sary for a small pool of Tim’s Law re­spon­dents, ad­vo­cates say.

The ques­tion, ad­vo­cates ask, is who will file pe­ti­tions with the courts un­der Tim’s Law? Some of the se­ri­ously men­tally ill do not have re­spon­si­ble adults in their lives ready to in­ter­cede.

“The way I see it, the pe­ti­tions are go­ing to have to be ini­ti­ated by the hos­pi­tals — by Cen­tral State and East­ern State — they’re go­ing to have to iden­tify their fre­quent fliers and then get the process started for us be­fore their pa­tients are dis­charged from an in­vol­un­tary stay so we can find a bet­ter way to han­dle this,” said Jef­fer­son District Judge Stephanie Pearce Burke.

“We’re al­ready late to the game on this,” Burke said. “And the thing is, it works in the places where they’re do­ing it.”

Some stud­ies have shown suc­cess­ful out­comes for as­sisted out­pa­tient treat­ment. A New York state study pub­lished in 2010 in the jour­nal Psy­chi­atric Ser­vices tracked 3,576 peo­ple un­der court or­der and found that, col­lec­tively, they spent less time in hos­pi­tals and were more likely to take their med­i­ca­tions than other men­tally ill peo­ple be­ing mon­i­tored by the state.

Blue­, a pub­licly funded non­profit that pro­vides men­tal health ser­vices in Lex­ing­ton, is ready to re­ceive Tim’s Law re­spon­dents for treat­ment, but fund­ing “is very tight” al­ready, said Don Rogers, chief clin­i­cal of­fi­cer. Moun­tain Com­pre­hen­sive Care Cen­ter, a sis­ter agency in East­ern Ken­tucky, has a $500,000, four-year fed­eral grant that could be tapped, if any­one in that area ever files a Tim’s Law pe­ti­tion, said project man­ager Martin Meade.

Gun­ning said that while it would have been nice if law­mak­ers pro­vided money, it’s a mis­take to put Tim’s Law on hold just be­cause they didn’t. Most of the men­tally ill who would be cov­ered by the law are likely to pass through court­rooms with a pub­lic de­fender and re­quire pub­licly funded men­tal health care re­gard­less, so it’s bet­ter if they are han­dled un­der this newer, more hu­mane sys­tem, Gun­ning said.

“Money shouldn’t be the be-all and end-all,” Gun­ning said. “What’s frus­trat­ing is how we’re do­ing this. Check the re­cidi­vism rates of peo­ple com­ing out of East­ern State Hos­pi­tal.”

She spun an in­dex fin­ger in a cir­cle on the table­top in front of her.

“Jail. Swish, swish. Hos­pi­tal. Swish, swish. Jail. Swish, swish. Hos­pi­tal. It just keeps go­ing,” she said “That’s the cy­cle we need to break.”

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