Friday, September 7, 2012

Kentucky stakeholders petition on behalf of mentally ill in Personal Care Homes

North Carolina settles with US Department of Justice in similar case

By Bruce Scott

The Secretary of the Commonwealth's Cabinet for Health and Family Services has deferred a response to a request for a meeting by Kentucky mental health stakeholders to discuss how Kentucky might provide community housing choices to the thousands of Kentuckians with psychiatric disabilities currently marooned in Personal Care Homes. The stakeholder group is named "Advocates for Community Options," and MHA-Kentucky is a member. The Secretary promised a response after the Legislative Research Commission finishes a study due in November.

The Kentucky stakeholder letter, sent July 18, argues that the state's system of Personal Care Homes, licensed and financially supported by the state, violates the Olmstead decision of the US Supreme Court. The Olmstead decision holds that the segregation of people with psychiatric disabilities in institutions violates the Americans with Disabilities Act (ADA).

A case statement accompanying the petition says that at least 1500 individuals with psychiatric disabilities lived in 81 Personal Care Homes and finds that housing and serving them in the community would be no more costly for most. Also sent with the petition were stories about individuals with psychiatric disabilities who are recovering in their own homes with evidence-based services and supports from stakeholder organizations like Permanent Supportive Housing. The mailing also included the recent satisfaction survey of PCH residents by Kentucky Protection and Advocacy.

Sharpening the issue is the announcement on August 24 that the State of North Carolina has settled with the US Department of Justice in a similar case advanced in the federal courts by a stakeholder group there. Here are some of the requirements of the North Carolina agreement, according to the Bazelon Center for Mental Health Law:

  • The state must develop 3,000 new units of supported housing over 7 years for people with serious mental illnesses living in large adult care homes with significant numbers of residents with mental illnesses, coming out of state hospitals, or diverted from admission to adult care homes.
  • The housing units must be permanent, afford tenancy rights, and enable people with disabilities to interact with people without disabilities to the fullest extent possible and must not limit access to the community.
  • Virtually all of these housing units must be scattered throughout the community.
  • The state must provide the array and intensity of services and supports necessary for these individuals to live in integrated settings.

A key service and support for individuals in the North Carolina settlement will be Assertive Community Treatment (ACT), an evidence-based practice that is widely available there but must now be expanded. The state is further required to bring its ACT services up to standards in the research literature on evidence-based practices. Except for a small team in Lexington, ACT is not available in Kentucky except for veterans through the Veterans Administration.

Advocates for Community Options will next meet in late September to review alternatives available through the US Department of Justice and in the federal courts. To join the group, contact Bruce Scott.

Bruce Scott is Secretary of the Board of MHA-Kentucky and served as Interim Executive Director. Previously, he was the Director of the Kentucky Division of Mental Health. He chairs the Kentucky Olmstead stakeholder group.


  1. There are some people with severe cognitive disabilities from their mental illness who cannot live in independent environment without the most intense of supports. To place them in scattered housing is not necessarily a good thing for all. There are congregate permanent supportive housing available that blends the two. It is important to assess support needs.

    I do not trust Bazelon entirely, as they do not support any form of Institutionalized care whatsoever, which the Olmsted decision did not support. In fact, it specifically warned against closing institutions and putting those who need that form of care at risk.

    Yes, we need more, permanent supportive housing...most will do well, but transition planning is very important, as is follow up, and need to make sure they get the supports they NEED.

  2. Ilene, thanks for your comments and suggestions. It always helps to learn from other advocates and how things are working, or not working in other states. Kentucky only has a few beds of transitional placements connected to 3 state hospitals. That leaves 1000s placed in single apartments that they can't manage or personal care homes, or mostly the streets. Hospitals give patients options such as supportive programs or PCHs, when released, yet many choose the streets instead. One reason I've been advocating for a revised AOT law was to discuss the need for step down programs, to integrate patients back into the community with supports and resources, not just a prescription in hand with an appointment to see a provider in a few weeks. Our state must learn that recovery can and does happen, and realize they can't force the newly diagnosed to fail over and over before they receive a supports -- by that time, (sometimes 10-15 years) their illness has cause irreversible brain damage.