Clinical Psychiatry News Reports: estimates 1 million people with serious mental illnesses are housed in US's jails and prisons!

Severe Mental Disorders Highly Prevalent in Jails, Prisons : Clinical Psychiatry News

Ky. managed care a bureaucratic maze ~ OP-ED by Edward L. Smith Jr.

Back in May, I warned that Gov. Steve Beshear's move to managed care would have a substantial negative impact on Medicaid. My concern was that it will take existing dollars away from services to pay for a layer of bureaucracy between the Medicaid department and the Medicaid providers and that the bureaucracy would sop up about 20 percent of the Medicaid budget for fees and profits. I worried that any savings would come from cutting services.

Now that the program has been implemented, things look much worse. Many Kentuckians are going to be seriously hurt.

Beshear has contracted with three out-of-state for-profit managed care organizations — Coventry Health and Life Insurance Co., WellCare Health Insurance Co. and Centene Corp. Each has formed a Kentucky corporation and each is required to have offices in Kentucky. They are contracting with service providers.

In addition, Passport of Louisville, had its contract renewed for one year. It is owned by Louisville hospitals and covers Jefferson and 15 nearby counties.

WellCare and Passport had management problems and upper levels of management were terminated. WellCare had to pay a fine of $170 million for misdeeds in Florida. All of this managed-care contracting was done unilaterally by the administration; the legislature had nothing to do with it.

Usually, a contracting process takes a year to 18 months. However, Beshear gave the MCOs 90 days to sign up providers and organize their lists of people getting services. That period was extended to Nov. 1.

Under the program, providers of Medicaid services (hospitals, primary care physicians, behavioral health care centers and others) were required to contract with each of the three MCOs. This means each provider will have three service payers to contend with instead of just one as before.

Adding to the complexity will be the need to keep track of the people who move in and out of Medicaid and between each of the companies. This will cause poor continuity of care. People will be treated later in their illnesses resulting in more expensive types of treatment.

Beshear said Medicaid managed care would create about 550 new jobs. That will create a huge surge of hiring by the companies, the service providers and the Medicaid department. MCOs need staff to keep up with all of the payment, authorization procedures and their lists of clients. Providers need staff to keep up with the three MCOs, each with their own billing, client lists and authorization methods. And, Kentucky's Department of Medicaid Services staff will go up so it can review the work done by the MCOs.

The money going to Medicaid services will be reduced because of the MCO-related bureaucracies. Worst of all, the MCOs have instituted plans to deliberately reduce the number of people allowed to access Medicaid services.

The MCOs have said they plan to eliminate computerization for a time and require paperwork instead. The theory is paperwork will slow down the authorization process from days to weeks, which will discourage some people from applying for Medicaid. Hence, a "savings."

They plan to make the authorization process more stringent, thereby denying more people access to services. More savings.

They plan to tangle up the payment processes by denying coverage for people who have dropped out of Medicaid before payments are made, causing headaches for the providers of those services, and by refusing services to people who need to get back into the Medicaid program later. That will discourage people from applying. More savings.

Previously providers and the people they served only had to deal with Medicaid. Now, people are initially assigned to a MCO which contracted with the provider treating them.

But, providers may contract with all the MCOs. When people drop out of Medicaid, they have an option to go to a different MCO. People have until next January to switch. The cost of keeping track of all this will be staggering and deducted from services.

In sum, there will now be four bureaucracies, with each sopping up Medicaid money to pay for the bureaucrats needed to keep track of everything. Where will the money for the bureaucrats come from? From services, of course. On top of that, Beshear cut the Medicaid budget by 4.5 percent in May and has set a target of saving $40 million a month under managed care.

How can he do that? By reducing services again. Nice job, Governor.

Read more: http://www.kentucky.com/2011/11/28/1975305/ky-managed-care-a-bureaucratic.html#ixzz1f3mBwIfH

Insanity - the Definition of Kentucky's Mental Health Laws at Work

My Shattered Daughter, My Love!
Written by "a Mom" from Lexington, KY

The morning my sixteen year old daughter’s doctor called to tell me she had schizophrenia, will forever be burned into my mind. My life dissolved into a blur … of grief, anguish, fear, bewilderment and finally rage. She was a wonderful daughter, bright, kind and mature beyond her years. Her future had seemed bright. Researching everything I could find about her illness I read of horrible suffering, shattered lives, lost potential, homelessness, drug addiction, imprisonment and death. I read of shattered families, pushed to the brink, forced finally to abandon a loved one to their fate. Not my daughter, I vowed. NO. Never. Only over my dead body could this damned disease have my sweet and gentle girl. I put all my faith in the medication and waited for it to take effect, but she was rapidly going downhill. The delusions became stronger. The voices were demons tormenting her. More medications were tried, but nothing helped.

I tried, on her doctor’s advice, to get guardianship for her. I was denied. The ruthless voices intensified, endlessly screaming and tormenting her. She became increasingly confused, and forgetful, leaving food cooking on the stove. She would disappear, sometimes for days. Clozapine, an antipsychotic that often works when other meds fail, came to the rescue. She became hallucination free for short periods. Her obsession with religion abruptly stopped.

Her senses told her she was possessed. How could taking a pill help with that? She could hear them and feel them. How could she possibly trust anyone who said they weren’t there? No one understood her. She stopped going to therapy and stopped taking her medications. Instead, she began to self-medicate with alcohol and illegal drugs. She was an adult and I had lost all control. Seven hospitalizations followed over the next year. She wanted help … yet she lacked insight to her illness or the ability to follow up for treatment outside the hospital.

Next came the group home. It seemed like the answer to a prayer. My daughter needed supervision and I wanted her away from the bad influences on the street. I quickly realized my mistake. She was constantly criticized there, for not doing her chores on time, even for the clothes she wore. Her lethargy, forgetfulness, and lack of organization were interpreted as spiteful behaviors, not symptoms of her illness. The promised help to get her to appointments turned out to be a bus pass! The director stated, “My schizophrenics are all very smart and manipulative.” I found this ignorance disturbing in people who were supposed to be mental health professionals. They decided to evict her in spite of desperately needing help. The director stated, “It is my job to make sure she doesn’t die on my program.” It was not the only time someone would promise to help her, then, when the seriousness of her problems becomes apparent, back off and blame her.

I wanted my child back under the care of the doctor she’d had through adolescence, who had given her a measure of stability. She liked and more importantly trusted him. He had a way of getting through to her, but her Medicaid would not cover it, and she would not keep her appointments with a doctor at Comprehensive Care, nor would she take her medications. Yet again, she was hospitalized … this time at Eastern State.

Then came the expected downward spiral of her life, the self-medication, living on the streets and being raped twice! On a friend's advice, I had her admitted to Our Lady of Peace in Louisville. It had a long-term program for co-disorders; mental illness complicated by substance abuse. I hoped this time would be different, that they could engage her and somehow make her see she needed treatment. I prayed that she would be there long enough for treatment to begin to work. I knew how much she had suffered and hoped that she had finally had enough. She called within a week…demanding that I come get her.

One bitterly cold night, she left in anger, intoxicated. I knew that if she passed out outside she would freeze. I would rather see her arrested. I called the police. I was told that there was nothing they could do. She had the right to be as sick and self-destructive as she chose…whether she was able to make that choice or not. There was nothing I, nor they, could do. It seems Kentucky's policy on mental illness is almost as effective as Adolf Hitler’s.

Life at home was chaos. My daughter stopped making any effort to be a part of the family or to help out. She broke windows and doors and punched holes in the walls. Twice, she was arrested for shoplifting the alcohol she frantically needed. I tried tough love, although I doubted she had the ability to comprehend that her circumstances were the result of her own actions. I told her to leave.

Soon, my daughter was arrested for probation violation from the shoplifting arrests. Relieved, I hoped she would be court ordered into treatment. Yet instead, she spent two months in jail!

She was released in far worse shape than before. She truly believed she was surrounded by angels and demons .... and that I was a demon, and there was a man burning in hell right beside her. Another trip to Eastern State resulted in her being released, just a few days later. She attempted suicide. After two days in intensive care, she was sent back to Eastern State Hospital.

Insanity, I have heard, is doing the same thing over and over yet expecting different results. By this definition the system is insane. My child has had nineteen hospitalizations and four arrests and is sicker today than before it all began. It is a waste of time, money and resources to keep hospitalizing her time and again, and then releasing her, still as psychotic and symptomatic as on admittance. I vote to just give all that money to me and I will retire with her in the Bahamas. At least someone would benefit from the money wasted.

As I write this, my daughter is in jail and I do not know what will happen. Tough love failed … she is too sick and too suicidal for it to be effective. She has given up and simply does not care what happens to her now. And me? I am far closer to giving up than I ever imagined possible. The reality is that there may be no chance for her. If the pattern now set continues there is not. Her life is a living hell, a nightmare even Stephen King would have trouble imagining. The hospital cannot hold her or force her to accept treatment unless she is an imminent danger to herself or someone else. She has learned to lie about that. At 24, she is trapped in a vicious cycle and with no way of keeping her in treatment, nothing will change. If nothing changes it will end in tragedy. Then when fingers are pointed and blame placed, it will be too late.

I miss my daughter. She has been sick for a third of her life, but I still cannot accept what has happened; nor understand why it must be. I tried all I know to do, even giving up, but finally, I am unable to give up hope no matter how hopeless it seems. We need a miracle, and I cling to the hope that it is not impossible, and that one day she can have peace, and sit in the sun and hear only the wind.
____________________________

Published and produced by friends of ~
The Change Mental Health Laws in Kentucky Project
ALL RIGHTS RESERVED!

 

The law failed our son!

Schizophrenic son shot police - MENTAL ILLNESS POLICY ORG.

www.mentalillnesspolicy.org

Thanks to DJ Jaffe for sharing this:

Karen and James Logan's mentally ill son shot two cops. Here is their short moving testimony on how the law prevented them from getting treatment for their mentally ill son and how that led to the shooting. Please join Mental Illness Policy Org in supporting efforts to reform laws in your state so people with mental illness can be treated before (not just after) they become danger to self or others. Thank you for all you do. http://mentalillnesspolicy.org/firstperson/paranoid-schizophrenia-son.html

Personal testimony by Karen and James Logan

Our son James Logan began exhibiting signs of paranoid schizophrenia. We recognized the symptoms because this serious disease had already occurred in his paternal grandmother and his uncle. We had taken him to the emergency room of a local hospital for treatment that night; we were told he should come back in the morning.

On Monday, August 26, 2002, our son went to the hospital and was seen by the attending psychiatrist and was told he should be admitted immediately for diagnosis and treatment. However, due to the nature of the illness, our son did not feel he needed any treatment and he refused to sign any hospital admission forms. Under current law physicians can not admit an adult into the hospital against their will, even though the individual is gravely disabled and incapable of making a rational decision about their well being. Currently they must present a danger to the life or safety of the individual or others. The doctor did not believe James met this criteria at that time. However, if he became violent, the doctor said we could call the police and ask them to bring James back to the hospital.

We continued to look for alternative treatment for our son to no avail. He refused all treatment because at the time he could not understand that he had a brain disorder that needed treatment.

As our son's condition deteriorated; it became obvious that his life as well as others could be in danger. Peace officers were called on August 28, 2002, however they did not witness any dangerous aggressive behavior so they did not petition for an emergency evaluation. The only choice set before us was to file a "Petition for Emergency Evaluation" with the Court. The petition requires the ruling by a Judge before an emergency evaluation can be done. Our son's condition had now become so severe we thought we could convince a Judge that the danger was imminent. The petition was authorized by the Judge.

By the time we were able to obtain the proper authorization for an emergency psychiatric evaluation on August 29, 2002, our son's condition had extremely deteriorated. Two Deputy Sheriffs lost their lives while trying to serve the "Petition for Emergency Evaluation." Our son has been incarcerated since this time, and our family has suffered greatly because of this tragedy. The families of the two Deputy Sheriffs are suffering as well. We have kept their families in our prayers and we will continue to do so.

If the attending psychiatrist had the authority to admit our son involuntarily under the gravely disabled standard (which did not pass the legislature last year), perhaps this tragedy would not have occurred.

The emergency evaluation standard currently proposed in SB 273 could also have averted this tragedy. Although SB 273 does not propose a gravely disabled standard, it does require the dangerousness standard for an emergency evaluation to be the same as the dangerousness standard for involuntary hospital admission. This could also have averted the tragedy. SB 273 would have allowed the peace officers on August 28, 2002, to take into account other pertinent information, enabling them to make a better decision. This would also have eliminated the traumatic experience of pleading with a Judge to grant a petition. Also, under SB 273 we could have petitioned for an evaluation before the danger was imminent.

Please vote in favor of SB 273. Save the lives of people who are ill through no fault of their own and others trying to help them. Prevent needless tragedy from striking more Maryland families.

"Families need backup", states Ron Thomas Father of man killed with SMI in CA

Kelly Thomas' father fights for justice

I have read reader's comments wondering "why" didn't this family keep Kelly Thomas at home? If he was so sick, then "why" didn't they protect him from potentially being a victim or living in the streets?

There is no way families can become the "institution" ... without mental health laws enforcing help or our "attitudes" changing. Families are forced to treat their loved "family member" worse than they would a stray animal! And then when tragedies occur, families are often blamed! Would society stand for treating a person with Alzheimer's this way? GG Burns, KY Mental Health Advocate

The family has become the institution. But it's an institution without training, without resources, and without the ability to enforce compliance. ~ Rael Jean Isaac, author of "Madness in the Streets"

Ron Thomas, a former cop, can't understand why his mentally ill son became the victim of a violent confrontation with Fullerton police. He won't rest until he finds answers. Read the entire story here:http://www.latimes.com/news/local/la-me-0807-lopez-kellythomas-20110805-lpc7gpnc,0,2514593.photo

The crowd stands and applauds as Ron Thomas is given more time to speak to the City Council Tuesday night. (Gina Ferazzi / Los Angeles Times / August 2, 2011)

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Another story echos that our prisons are the new mental health institutions ...

We live in a "reactive" society. We force family members to wait until it's too late to help their loved ones spiraling out of control. We have no safety nets.

Dan Morain: California lets the mentally ill refuse treatment -- until it's too late

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By Dan Morain, Senior editor
dmorain@sacbee.com The Sacramento Bee

Published: Sunday, Aug. 7, 2011 - 12:00 am

Read more: http://www.sacbee.com/2011/08/07/3820169/dan-morain-california-lets-the.html#ixzz1USGrTJFf

What Should Kentucky Do? Suggestions for Amending KY's Mental Health Laws

"The Untapped Power of AOT in Kentucky"

Suggestions for Kentucky, on how to improves it's 'outpatient treatment law' from Brian Stettin, Policy Director of the Treatment Advocacy Center.

Click here to review notes from Brian's workshop held at the NAMI KY 2013 annual conference, on July 20. 2013. 


http://changementalhealthlawsinky.blogspot.com/2013/08/nami-kentucky-state-conference.html

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On July 30, 2011, approximately 150 mental health advocates, individual living with mental illness, their family members, mental health providers or law enforcement professionals attended workshops at the NAMI KY conference in Louisville, KY. One class helped members learned more about the current out-patient treatment laws and why the current law needs amending. The workshop concept was inspired by GG Burns, founder of "Change Mental Health Laws in Kentucky Project", (based on her personal struggles with a family member) and by a well known mental health professional, Ms. Rita Ruggles, MSW of Naples, Florida.

Ms. Ruggles, broke down a very complex subject into bite size pieces. Several family members in the audience reported they were unable to obtain medical attention for their loved ones, who suffered with psychotic episodes and lack the ability to agree to treatment on their own. Others reported they had never heard of the KRS 202(A). One NAMI affiliate leader spoke of not only was this law underutilized, it is sometimes NOT supported in many regions of the state, even when a very sick person finally receives AOT!


GG reported, "until KY’s Mental health laws are amended, services and treatment will continue to be unavailable for a small population of people who do not believe they are sick due to a symptom of their brain disease called anosognosia". Consequently according to state data, this group is taking up too much of Kentucky's resources in the corrections, criminal justice and law enforcement budgets.

What Should Kentucky Do?

Click on 'How to Advocate for AOT in KY' Fact Sheet Here:

http://changementalhealthlawsinky.blogspot.com/2012/07/how-to-advocate-for-aot-in-kentucky.html
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NAMI Kentucky Conference outline to "Closing the Loop" presentation
July 30th, 2011

By: Rita Ruggles, MSW
Clinical Director for the David Lawrence Center in Naples, Florida

GG Burns, Mental Health Advocate

__________________________________

Workshop Goals ... to

• Gain an understanding of the Assisted Outpatient Treatment.
• Gain an understanding of KRS 202A
• Gain an understanding of civil commitment criteria pursuant to Kentucky
Revised Statute ( KRS) 202A.
• Gain an understanding of other states civil commitment criteria.
• Gain an understanding of an agreed outpatient order and the stipulations outlined
in KRS 202A.
• Gain an understanding of the types of situations that warrant assisted outpatient
treatment.
• Gain understanding of NAMIs efforts to advocate for clear language in the states statutes that address assisted outpatient treatment.
__________________________________


What is Assisted Outpatient Treatment?

• Assisted Outpatient Treatment (AOT), formerly known as involuntary outpatient commitment (IOC), allows courts to order certain individuals with brain disorders to comply with treatment while living in the community.

• Assisted Outpatient treatment was initially proposed in the early 1980's by families of individuals with the most serious mental illnesses as a way to help their loved ones. Individuals with disorders like schizophrenia often need medicines to enable them to control their own thoughts and behavior. But sometimes, they don't recognize they are ill ("Anosognosia") and therefore see no need to be in treatment.

• These individuals often decompensate; commit suicide; become homeless persons with mental illness; end up in jail; or, on rare occasions, are involved in acts of violence. Family members and caregivers were not allowed to intervene until 'after' the individual "became danger to self or others". Many felt the law should prevent dangerousness, rather than require it.

• Once the family member deteriorated to the point of dangerousness, the only thing police could do was involuntarily commit the individual to inpatient hospitalization.

• Families believed that committing someone to receive services on an outpatient basis was kinder, more humane and less expensive than inpatient. In addition, it could prevent the person from deteriorating in the first place.

• AOT is NOT an alternative to voluntary services. It is a way to see that services get utilized by those who reject voluntary services and are likely to needlessly decompensate as a result.

__________________________________

Why Advocate for AOT?

• Assisted Outpatient Treatment is an important advance.

• AOT allows individuals to be court-ordered into treatment without ordering them into a hospital. It is a less-restrictive, less-expensive, more humane form of 'commitment' than inpatient commitment.

• The criteria to place someone in assisted outpatient treatment are easier to meet than the "imminent dangerousness" standard often required for inpatient commitment. AOT allows someone to be ordered into treatment "to prevent a relapse which or deterioration which would likely result in serious harm to the patient or others." Prior law required 'dangerousness', Assisted Outpatient Treatment prevents it.

• The court order not only commits the patient to accept treatment, the court order also commits the mental health system to providing it. Prior to AOT, many treatment providers preferred to exclude the most seriously ill.

__________________________________


The PRO’s

While many outpatient commitment laws have been passed in response to violent acts committed by people with mental illness, most proponents involved in the outpatient commitment debate base their arguments on the quality of life and cost associated with untreated mental illness and "revolving door patients" who experience a cycle of hospitalization, treatment and stabilization, release, and decompensation. While the cost of repeated hospitalizations is indisputable, quality-of-life arguments rest on an understanding of mental illness as an undesirable and dangerous state of being. Outpatient commitment proponents point to studies performed in North Carolina and New York that have found some positive impact of court-ordered outpatient treatment.
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The CON’s

Outpatient commitment opponents make several varied arguments. Some dispute the positive effects of compulsory treatment, questioning the methodology of studies that show effectiveness. Others highlight negative effects of treatment. Still others point to disparities in the way these laws are applied. The psychiatric survivors movement opposes compulsory treatment on the basis that the ordered drugs often have serious or unpleasant side-effects such as tardive dyskinesia, neuroleptic malignant syndrome, excessive weight gain leading to diabetes, addiction, sexual side effects, and increased risk of suicide. The New York Civil Liberties Union has denounced what they see as racial and socioeconomic biases in the issuing of outpatient commitment orders.
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The Outcomes

In 2005 and 2009, the New York Office of Mental Health conducted an outcomes study related to the provision of assisted outpatient treatment:

74 percent fewer experienced homelessness;
77 percent fewer experienced psychiatric hospitalization;
83 percent fewer experienced arrest; and
87 percent fewer experienced incarceration.

Efficacy of services provided under an assisted outpatient treatment orders

Comparing the experience of outpatient commitment recipients over the first six months of commitment to the same period immediately prior to commitment, the OMH study found:

• 55 percent fewer recipients engaged in suicide attempts or physical harm to self;
• 49 percent fewer abused alcohol;
• 48 percent fewer abused drugs;
• 47 percent fewer physically harmed others;
• 46 percent fewer damaged or destroyed property; and
• 43 percent fewer threatened physical harm to others.
__________________________________

Kentucky’s Civil Commitment Law

KRS 202A – A Work in Progress
• Major Amendments in the early 90s
I. The Criminalization of Mental Illness
• E. Fuller Torrey National Report
• Worst state in the nation designation
• Decriminalization Project (HB 207)

II. Task Force on Violence and Persons with Mental Illness

Recommendations for statutory language changes in both KRS 202A and KRS 504

Criteria for Involuntary Admission, current KRS 202a reads that in order for a person to be involuntary committed to a hospital for up to 72 hours ...

• Person has to have a mental illness; and Be expected to benefit from treatment; and Be a danger to self or others; and Hospitalization has to be the least restrictive environment.

Compare the wording in Florida' s Baker Act:

A voluntary Baker Act admission occurs when a person 18 years of age or older, or a parent of a minor, applies for admission to a facility for observation, diagnosis, and treatment.

An involuntary Baker Act admission occurs upon a finding by a court that (1) a person is mentally ill and, because of the mental illness, he/she has refused voluntary placement for treatment or is unable to determine whether placement is necessary; (2) he/she is incapable of living alone or with help, and without treatment is likely to suffer from neglect or refuse to care for him/herself, or there is a substantial likelihood in the near future that he/she will inflict serious bodily harm on him/herself/others as evidenced by recent behavior; and (3) all less restrictive treatment alternatives are not appropriate.

KRS 202 A/ KAR 908:209

Definitions: Criteria, Facility, Hospital

Three Pathways in …
(1.) 72 Hour Hold
(2.) 72 Hour Court Order
(3.) Warrantless Arrest

202A.081 Court-ordered community-based outpatient treatment.

(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.

504 Interface with KRS 202A

504 is the Kentucky law that addresses a persons criminal responsibility in criminal cases.
• Persons may be found competent to proceed, incompetent to proceed and restorable or incompetent to
proceed, not restorable.
• Kentucky Corrections Psychiatric Center in Lagrange is the state forensic facility. Forensic evaluators
are also available on an outpatient basis.
• Differentiate between competency and criminal responsibility.
• Competency - Ability to understand the charges and participate in their own defense
• Responsibility - Speaks to the individual’s state of mind at the time of the crime.

504.110 Alternative handling of defendant depending on whether he is competent or incompetent to stand trial.

(1) If the court finds the defendant incompetent to stand trial but there is a substantial probability he will attain competency in the foreseeable future, it shall commit the defendant to a treatment facility or a forensic psychiatric facility and order him to submit to treatment for sixty (60) days or until the psychologist or psychiatrist treating him finds him competent, whichever occurs first, except that if the defendant is charged with a felony, he shall be committed to a forensic psychiatric facility unless the secretary of the Cabinet for Health and Family Services or the secretary's designee determines that the defendant shall be treated in another Cabinet for Health and Family Services facility. Within ten (10) days of that time, the court shall hold another hearing to determine whether or not the defendant is competent to stand trial.
(2) If the court finds the defendant incompetent to stand trial but there is no substantial probability he will attain competency in the foreseeable future, it shall conduct an involuntary hospitalization proceeding under KRS Chapter 202A or 202B.
(3) If the court finds the defendant competent to stand trial, the court shall continue the proceedings against the defendant.

__________________________________

Closing the Loop Between KRS 202A and 504

• The problem for the Commonwealth arises when individuals are found incompetent to proceed yet may not meet the stringent criteria for civil commitment.
• Civil commitment criteria is different than criminal responsibility and competency therefore many individuals fall through the cracks in the system.
• This leads to multiple arrests, expensive court and law enforcement expenses, additional victims and a revolving door life for the individuals who are struggling with the mental illness and justice system involvement.
• The key to addressing this issue is an amendment of either KRS 504 and 202A that will require outpatient treatment in lieu of hospitalization or following hospitalization of a person with mental illness who are incompetent to proceed.
__________________________________

Recommendations

• Review the recommendations issued by the Task Force on Violence and Mental Illness issued in the late 90’s and re-issued by the Criminal Justice/Behavioral Health Interface work group of the HB 843 Commission.
• Assign a staff person within the Department to specialize in the states Civil Commitment Law and Forensics.
• Consult with Legislators interested in this issue. (Rep. Tom Burch). Prior draft language for amendments should be available.
• Form a state level policy group to build on the prior work and validate historical information and to work with a sponsor and their staff to design a bill for the 2012 session.

Kentucky needs to "rebalance" their properties.