Kentucky's legal policy for assisted outpatient treatment, AOT.
(1) Following the preliminary hearing but prior to the completion of the final hearing,
the court may order the person held in a hospital approved by the cabinet for such
purpose for the committing judicial district, or released, upon application and
agreement of the parties, for the purpose of community-based outpatient treatment.
No person held under this section shall be held in jail unless criminal charges are
also pending.
(2) A hospital shall discharge a patient there held and notify the court and attorneys of
record if any authorized staff physician determines that the patient no longer meets
the criteria for involuntary hospitalization.
(3) If a patient is discharged by the hospital pursuant to subsection (2) of this section,
then the proceedings against the patient shall be dismissed.
(4) The release of the person pursuant to subsection (1) of this section for the purpose of community-based outpatient treatment does not terminate the proceedings against the person, and the court ordering such release may order the immediate holding of the person at any time with or without notice if the court believes from an affidavit filed with the court that it is to the best interest of the person or others that the person be held pending the final hearing, which shall be held within twenty-one (21) days of the person's further holding.
(5) If the person is released pursuant to subsection (1) of this section for the purpose of
community-based outpatient treatment, the final hearing may be continued for a
period not to exceed sixty (60) days if a provider of outpatient care accepts the
respondent for specified outpatient treatment. Community-based outpatient
treatment may be ordered for an additional period not to exceed sixty (60) days
upon application and agreement of the parties.
Effective: July 15, 1994
History: Amended 1994 Ky. Acts ch. 498, sec. 6, effective July 15, 1994. -- Amended
1988 Ky. Acts ch. 139, sec. 8, effective July 15, 1988. -- Created 1982 Ky. Acts
ch. 445, sec. 10, effective July 1, 1982.
Legislative Research Commission Note. This section was enacted in 1982 Acts,
Chapter 445, which contains the following language in Section 45 of that Act: "This
Act shall become effective on July 1, 1982." The Ky. Constitution, in Section 55,
requires that a reason be set forth for the emergency. However, no reason is set forth
in this Act. The effective date for 1982 Acts with no emergency provision is July 15,
1982.
Monday, October 29, 2012
Saturday, September 29, 2012
Did you know?
By: Robert Friedman, Attorney with the Department of Public Advocacy in Lexington, Kentucky
KRS 202A.251 Prohibition against detention in jail without criminal charges pending --Criminal charges not to be placed to avoid transportation.
No person held under the provisions of this chapter shall be detained in jail unless criminal charges are also pending. No peace officer or any other person shall place criminal charges against a person who is mentally ill and in need of hospitalization pursuant to this chapter solely or primarily for the purpose of avoiding transporting the person to a hospital or psychiatric facility.
This is the law, but it it widely disregarded. A lot of police officers are simply unaware of it. A few just wink at it and take persons with mental illness to jail.
Here’s the “cash value”: if the officer knows the person is mentally ill and thinks he/she might be dangerous, the officer cannot legally place charges without taking the person for a psych exam first.
People need to demand that the police observe the law ... probation officers, too. If your elected officials turn away when you bring it up, vote the crooks out!
Otherwise, people with serious, chronic, mental illnesses—schizophrenia, bipolar I, schizoaffective disorder—end up getting arrested for petty garbage—criminal trespass 3rd, disorderly conduct—and taken to jail.
This is both cruel to person with mental illness and costly to the public. (Jail ain’t cheap to the taxpayers, nor should it be.) We don’t have to change the law to do better. We just have to know it and observe it.
Note: "These are my views, and I am not speaking on behalf of the DPA." ~ Robert Friedman
Friday, September 14, 2012
AOT Myths: Debunked
AOT Myths: Debunked
There is a lot of misinformation about assisted outpatient
treatment.
Here is a quick look at some of the myths and realities
involved.
MYTH: Assisted Outpatient
Treatment is going to fill hospital wards.
REALITY: Assisted Outpatient Treatment is designed to help
people succeed out of the hospital. It helps those with a history of
non-compliance induced dangerousness comply with treatment and therefore
prevents them from deteriorating to the point where they need hospitalization.
MYTH: Assisted Treatment
will empty hospital wards.
REALITY: Inpatient hospitalization will still be needed for
those incapable of surviving safely in the community. Assisted outpatient
treatment facilitates early short-term rehospitalization for those noncompliant
and likely to become dangerous.
MYTH: Assisted outpatient
treatment does not work.
REALITY: Studies in Iowa, North Carolina, Hawaii, Arizona and
other states have definitively proven assisted outpatient treatment works.
MYTH: Assisted Outpatient
Treatment will bust the budget.
REALITY: Assisted Treatment is not expensive because it does
not mandate any services that individuals with brain disorders are not already
entitled to (example: case management, medications, rehabilitation). Assisted
Outpatient Treatment Orders merely require the system to facilitate compliance
for non-compliant individuals by giving them the services they need to keep
well and the surrounding community safe.
MYTH: Assisted outpatient
treatment is unconstitutional.
REALITY: Forty-one states and the District of Columbia have
assisted outpatient treatment laws. The Supreme Court has overturned none of
these laws.
MYTH: Assisted treatment
infringes on civil liberties.
REALITY: It is the illness,
not the treatment that restricts civil liberties. Medicines can free
individuals from the “Bastille of their psychosis” and enable them to engage in
a meaningful exercise of their civil liberties. Assisted outpatient treatment
cuts the need for incarceration, restraints, and involuntary inpatient
commitment, allowing individuals to retain more of their civil liberties.
For
more information: www.treatmentadvocacycenter.org
Anosognosia Fact Sheet
When a
person cannot appreciate that they have a serious psychiatric illness, a
tremendous challenge to family members and caregivers follows. About one-half
of people living with schizophrenia, and a smaller percentage who live with
bipolar disorder, have this clinical feature. Individuals with Alzheimer's
disease and dementia also often have this feature. The medical term for not
seeing what ails you is anosognosia, or more commonly known as a lack of
insight. Having a lack of awareness raises the risks of treatment and service
nonadherence. From the person's point of view, if they feel they are not ill
why should they go to appointments, take medication or engage in therapy?
Why can't
a person see what is so apparent to those around them? The best thinking
indicates this is a core feature of the neurobiology of the conditions. Frontal
lobes organize information and help to interpret experiences. In conditions
like schizophrenia and Alzheimer's disease, frontal lobe difficulty is central
to the neurological processes that underlie the disorders. Psychological denial
is not the reason for the lack of insight in these illnesses.
There are
situations where a person's lack of insight can, at times, create dangerous situations.
This combination of no insight and dangerous acts often requires intervention.
In more than 40 states, there are laws for Assisted Outpatient Treatment (AOT),
also known as outpatient commitment. AOT status requires a person to engage in
treatment and gives the state authority to bring the person to a treatment
center if they do not. All states that have these laws have protections and a
process for assessing whether this intervention is appropriate. In most states,
doctors are required to submit an affidavit of the person's state and the
reasons for the requested AOT status and a judge decides.
NAMI: www.nami.org
AOT:
For a list of current state laws see www.treatmentadvocacycenter.org
Violence Against Homeless Persons
In the dark hours early on August 27, while sleeping behind a building near Winchester Road in Lexington, a 61-year-old homeless man was set on fire. He is currently in intensive care at UK hospital, but is expected to survive. So far the police have no suspects in this hate crime.
However, the incident is not considered a hate crime at all because current law does not include homelessness as a eligible category for such an offense. The National Coalition for the Homeless is seeking to change that. In their on-going effort to highlight this type of crime, they publish a bi-annual report detailing their research into hate crimes committed against homeless people. In their most recent edition, Hate Crimes against the Homeless: Violence Hidden in Plain View, they tabulated these crimes from across the country. Kentucky is barely noted in their statistics with just 3 incidences in the last twelve years (California had 225 and Florida 198). These statistics exclude any acts of violence committed by homeless individuals against each other and a crime is included only if the attack was primarily motivated because the victim was a homeless person. The scope of the problem is highlighted in the report as follows:
"Over the past twelve years (1999-2010), hundreds of homeless people have been attacked and killed. While this report provides alarming numbers, many attacks go undocumented. Homeless people are treated so poorly by society that their attacks are often forgotten or unreported. In 2010 alone, one hundred thirteen incidents resulted in twenty-four deaths. Since 1999, The National Coalition for the Homeless has recorded one thousand, one hundred eighty-four acts of violence that have resulted in three hundred twelve deaths".
Another section of the report seeking to understand factors associated with these hate crimes, states that:
"There is a documented relationship between increased police action and the increasing numbers of hate crimes/violent acts against homeless people. Many cities...... have enacted severe anti-camping, panhandling, anti-feeding, and other criminalization of homelessness laws. Many of these cities ..... are also cities where hate crimes against homeless individuals have frequently occurred. One possible explanation for this is the message that criminalizing homelessness sends to the general public: “Homeless people do not matter and are not worthy of living in our city.” This message is blatant in the attitudes many cities have toward homeless people and can be used as an internal justification for attacking someone who is homeless".
Homelessness in Lexington has been accorded increased attention recently with a number of city ordinances proposed to our City Council and now under review, including such items as a "nuisance" ordinance to give police more options to control unwanted street behavior and another proposed ordinance change that requires any group planning to open a daytime drop-in center for homeless persons to undergo greater public scrutiny before being allowed to proceed. In addition, the city's Board of Adjustment is moving forward with closing down the Community Inn, a shelter for homeless men and women operated under the auspices of Emmanuel Apostolic Church.
The Mayor has recently established a Commission on Homelessness to address these and other homeless issues in Lexington. Given concerns about increasing violence against homeless persons and public policies that seek to criminalize homelessness, it seems far better for our city to approach concerns regarding homelessness in a collaborative and compassionate way as an inclusive community and not slip into the ugly and hostile patterns to which some cities have succumbed. As we increasingly move toward objectifying homeless persons as "them" and not "us", we risk our sense of community.
"We are not enemies, but friends. We must not be enemies. Though passion may have strained it must not break our bonds of affection". It is time to better appreciate these words spoken by Kentucky's most famous native son, Abraham Lincoln. Our city will be far better served by allowing ourselves to listen to "the better angels of our nature", as Lincoln suggested, as we seek to understand and find solutions for homelessness. Demonizing our homeless neighbors as the enemy will only lead to more fear, hatred and violence.
David Christiansen, MSW
Executive Director
Central Kentucky Housing and Homeless Initiative
Read the edited version of David's Story here on the LHL.
Demonizing the homeless leads to fear and violence
http://www.kentucky.com/2012/09/10/2330686/demonizing-the-homeless-leads.html
Mental Health Diversity from Kentucky's Appalachians
[A Peer Recovery Support Specialist (P-RSS) is an occupational title for a person who has progressed in their own recovery from alcohol or other drug abuse or mental disorder and is willing to self-identify as a peer and work to assist other individuals with chemical dependency or a mental disorder. Because of their lived experiences, such persons have expertise that professional training cannot replicate.]
Waltr Lane, has been described by some as a controversial Appalachian social commentator. His first person stories about resisting authority, moon shining, dynamiting fish and cockfighting have made him a person of interest across Kentucky. Waltr, (a hit and run survivor) is married, has a family and is a contract employee of The United Mine Workers of America.
Please read Waltr's story and poem and learn from his words. Additionally, consider how ‘supportive employment' and evidence best practices combined with an AOT law could help individuals stay out of jail and give them the incentive to stay in treatment, therefore assisting them to find the 'bridge to recovery'. GG Burns - KY Mental Health Advocate
______________________________________
Recoverized, But NOT Cured By:Waltr Lane, who lives in Eastern Kentucky and is a Certified Peer Recovery Support Specialist.
When I was put in jail for loitering, people said that made me a certified public nuisance. It really didn’t annoy me, because I was happy in jail. I had more freedom there than in the State Mental Hospital. Besides, the coffee tasted better.
I have always had problems with being therapized. Years ago, I believed a live psychologist. Many times the psychologist said she threatened to kill the President of the United States and nothing happened (that is freedom of speech). I decided I wanted to threaten somebody more important than that. I started threatening the President of the University, because he was someone everyone knew.
Wham! Bam! There were carloads of cops and off to jail I went for loitering. The police had more sense than that lying psychologist. Threatening people is called terrorist threatening and a 'go directly to jail' offense. Yet police are discreet and use common sense. They didn’t want to publicize our stupidity. I was arrested for loitering and then shipped to the state mental hospital. The hospital social worker told me the judge sent word that I would be in jail or the hospital until I got out of the city. I have been run out of the city but I went to trial and plead guilty and apologized. The judge asked me how he could stop me from loitering. I said that I had nothing else to do.
And, bam, back to jail I went and then back to the state hospital, where I have spent several seasons off and on.
I finally escaped from a locked ward and hitchhiked home to the mountains. I went to the local Mountain Mental Health Center. Idleness is the enemy of good behavior. So the therapist helped me find a minimum wage job. I behave for the money. This paid more than the Pepsi a day I made working in the hospital. I have been therapized, psych rehabbed, recoverized -- but never cured.
Recently, I imagined something again. It was recommended that I imagined to regale the staff at the mountain state hospital about how I enjoyed my stay. I thought I was to talk about every available male staff laying hands on me at once as a pacification technique. Because of the nature of the questions the schedule maker asked, I thought I was to give a first person account of some inherently private experiences. My wife, who heard the state man give me the date and time, shared my delusional ideation. But he never called back and said I misunderstood.
Apparently the hospital man had contacted a PhD person for the politically correct and official view of mental hospital life from an academic standpoint. I ain’t cured but I know better than to argue with the hospital man’s story.
I wonder why publishers print my writings and I get to speak nearly everywhere except I wasn’t going to speak in the next state where I was given a printed invitation and not interviewed. I still ain’t. I don’t like going where people recognize that a satirist is a dangerous person to mislead.
The Hillbilly Poet, Prison for Minds
By: Waltr Lane
The four staff sat in a circle seance,
Keyboarding iPhones in a silent gaze,
Ignore the mental patients,
Who gave their raison d"etre.
A mental ward is another climate
where emotional winds
blow not from God's reason.
Forgive me, I pray, for saying
Sex is a necessity
Rape is not.
The psych ward staff pronounces,
Karen gives people an evil look;
Grabbing their momentary attention.
It is easy to ignore,
those who are social mutes.
The Hillbilly is the only witness
with a voice:
He cries, "help my people"
out of this prison
without bars.
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.
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