Tim Morton was hospitalized for psychiatric treatment dozens of times over 36 years, often involuntary and in police handcuffs, because he did not recognize that he had schizophrenia. He refused treatment unless he was confined. When Morton wasn’t held inside Eastern State Hospital, he spent his days walking aimlessly around downtown Lexington.
Like many mentally ill Kentuckians, Morton was neither dangerous enough to be kept in a hospital for long nor healthy enough to care for himself in the community. Malnourished, a heavy smoker, he was beaten at least once by a group of youths. He died in 2014 from long-neglected health problems. He was 56.
On Thursday, the House Health and Welfare Committee approved a bill to let some mentally ill Kentuckians be ordered by judges into outpatient medical treatment, a step shy of institutionalization, with public defenders representing them at hearings and caseworkers monitoring their daily progress. Part of the bill would be called “Tim’s Law,” for Tim Morton.
If successful, House Bill 94 would “keep people out of the revolving door of the hospital,” Sheila Schuster of the Kentucky Mental Health Coalition told the committee.
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“Folks, I’m here to tell you that what we’re doing now simply does not work,” Schuster said.
Rep. Tom Burch, chairman of the House committee, said he suspects that most Kentucky families have at least one relative who suffered Morton’s fate, which Schuster related to the lawmakers.
It’s not very pleasant, to see someone you love go down the tubes because they’re mentally ill.
State Rep. Tom Burch, D-Louisville
“My cousin died at a young age from the very same thing that Sheila was talking about,” said Burch, D-Louisville, urging his colleagues to support the bill. “It’s not very pleasant, to see someone you love go down the tubes because they’re mentally ill. And we did not have the capability at that time to deal with those sorts of things.”
A previous version of HB 94 passed the House Health and Welfare Committee during the 2015 session but bogged down in the House budget committee. That’s also this bill’s likely next destination, Schuster said, because it comes with a price tag: $1.5 million from the two-year state budget to pay for public defenders needed to represent the mentally ill at the new hearings.
Most states have adopted some version of “assisted outpatient treatment” since the 1980s, when families of the mentally ill began to lobby for it.
By some estimates, as much as half of the people who suffer from mental illnesses, including bipolar disorder or schizophrenia, don’t recognize that they’re sick — a condition known as anosognosia — and so they refuse the treatments that could stabilize their thoughts and behavior. These people can end up homeless, commit suicide, land in jail repeatedly for nuisance crimes or, on rare occasions, lash out violently.
Police or family members can have the mentally ill involuntarily committed to a hospital for treatment once they deteriorate to the point that they pose a threat to themselves or others. But this is considered an imperfect solution for many reasons. In Tim Morton’s case, his family said he would accept medication long enough to be released, and then he would quit taking it.
HB 94 would let district courts order outpatient treatment for someone through a community mental health agency after getting a petition from the person’s family, friends or legal guardians or law enforcement or medical professionals.
First, at a hearing, a judge would decide whether the person met various criteria, including having a severe mental illness, symptoms of anosognosia, a likelihood that he would be a danger to others and a determination that outpatient treatment was the least restrictive alternative available.
If an individual ordered to outpatient treatment later refused to cooperate, the judge could order him involuntarily committed to the hospital. The courts would report data from each case to a state agency that would monitor the success of the law.
There’s tremendous cost savings, so I’ll make the fiscal argument for you. But think of the personal argument. Think of the human cost to someone who has been treated that way because we’ve had no other way to get them to take their medication and follow their treatment regimen.
Sheila Schuster of the Kentucky Mental Health Coalition
Studies generally show 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, as a group, they spent much less time in a hospital and were more likely to take their medications than other mentally ill people being monitored by the state.
Schuster said the criteria for assisted outpatient treatment is specific enough in HB 94 that she only would expect about 25 people a year to qualify. One advantage for Kentucky, she said, is that mental health hospitalization is paid for entirely by the state’s General Fund, while outpatient care is billed to Medicaid, with the federal government paying 70 percent.
“There’s tremendous cost savings, so I’ll make the fiscal argument for you. But think of the personal argument,” Schuster said. “Think of the human cost to someone who has been treated that way because we’ve had no other way to get them to take their medication and follow their treatment regimen.”
HB 94 also would add a section to the existing law on involuntary commitments that would let patients be discharged from the hospital if they agreed to participate in assisted outpatient treatment.
The state Department of Public Advocacy, which oversees the public defenders, is raising two objections to the bill. One, Public Advocate Ed Monahan said court-ordered treatment might be coercive and a violation of individual rights. Two, the cash-strapped public defender system handled nearly 4,000 involuntary commitment hearings at eight locations around the state in 2015, and officials say they’re wary of being assigned still more mental-health work.
Unlike Schuster’s estimate of 25 people a year, DPA officials put the possible number of assisted outpatient treatment cases at “almost 2,000,” based on their existing caseload and how many of their clients suffer from anosognosia.