Sometimes they arrive by taxi from area hospitals with little more than an address — 400 E. Fifth Street — scribbled on a piece of paper.
For those with no family, no money, no insurance and in most cases, a history of severe mental illness, the Catholic Action Center on Fifth Street is the only place to go.
"We have the most marginalized of the marginalized population," said Ginny Ramsey, co-founder of the Catholic Action Center. "These folks haven't just been overlooked, they've been cut out."
They come to the Catholic Action Center because the public mental health system — their safety net — has gaping holes that are growing larger. The system is frayed to the point of breaking, mental health advocates and those inside the system say.
In April, Ramsey quit sending her clients to Bluegrass Comprehensive Care, a community mental health center in Lexington that relies heavily on state funding, because the wait to see a doctor was sometimes 60 to 90 days. Bluegrass has great staff, Ramsey said. There just aren't enough of them.
"They can't wait six weeks for an appointment," Ramsey said of her clients.
Other mental health centers across the state can no longer see new patients with less severe mental illness, such as depression, if they can't pay the minimum fee. Waits are longer between appointments. Clinics are being closed and services consolidated.
If you call a 1-800 crisis and information number in Louisville, you might be put on hold.
"I've been doing this for 30 years, and I've never seen it this bad," said Sheila Schuster, a mental health advocate.
With the possibility of more cuts looming, things could go from bad to worse.
For the past 13 years, state funding for community mental health centers — which were started more than 30 years ago as a way to treat those with mental illness without hospitalization — has remained the same.
The centers lost $3.5 million in state funding earlier this year and could face an additional $4 million cut as Beshear considers asking for 4 percent reductions from state agencies to stave off a projected $456 million shortfall in state revenues.
The entire community mental health system — which consists of a network of services in 14 different communities — receives approximately $95 million a year from the state.
Officials with the Cabinet for Health and Family Services, which oversees the state community mental health system's budget, declined to comment on the specifics of their budget recommendations until Beshear makes an announcement about his plans next week. But the possibility of more cuts couldn't come at a worse time.
"There is ample data out there that shows that when the economy gets worse, the demand for services increases," said Steve Shannon, the executive director of the Kentucky Association of Regional Programs, the trade group for community mental health centers. "When the employment rate drops, the suicide rate increases."
Turning patients away
Seven Counties Services, the community mental health center in Louisville, has reduced staff through attrition, consolidated clinics and tried a host of other cost-cutting measures before it looked at cutting programs and services, said Dean Johnson, vice president of community relations for Seven Counties.
Seven Counties had to eliminate a clubhouse for recovering teen drug and alcohol addicts. They cut a respite care service for 300 families caring for disabled people. Seven Counties had to eliminate or reduce some prevention programs — including a program to help pregnant women quit smoking.
"We've had to reduce staffing levels at our crisis and information center," Johnson said. "We've seen an increase in wait time for callers. More people are now hanging up."
And Seven Counties can no longer see new patients with less severe mental illness unless they have insurance or the ability to pay.
"If you suffer from depression or a debilitating anxiety disorder and can't afford to pay for treatment or counseling, chances are there is not anybody in the system right now to help you," Johnson said. "That part of the safety net is truly gone. If you have a diagnosis of bipolar disorder or schizophrenia, you will get service."
Bridgehaven Mental Health Services in Louisville, a non-profit that provides intensive outpatient mental health services, has had to turn away new clients, for the first time in its 50-year history, who don't have insurance or can't pay.
"We're expecting to turn away 100 new patients by the end of this fiscal year," said Ramona Johnson, president and CEO of Bridgehaven. Some of the patients Bridgehaven has turned away include a 65-year-old man suffering from severe depression and a female Navy veteran with a bipolar disorder.
Funds running out
In Lexington, Bluegrass Comprehensive Care, which is part of the Bluegrass Regional Mental Health and Mental Retardation Board, has not turned anyone away. Yet.
"We use up all of our (state funding) in a few months," said Shannon Ware, vice president of administration and operations for Bluegrass.
Bluegrass receives approximately $14.5 million a year from the state. But last year, Bluegrass gave away $7 million in charity care because state funding, which helps pay for those who cannot pay minimum fees, dried up. Medicaid, a health insurance program for poor and disabled people, pays for many psychiatric services. However, the state has kept its reimbursement rates — the amount it pays clinics — for Medicaid frozen for eight years.
"We are providing care at a level that we are not being reimbursed for," Ware explained.
Bluegrass is still trying to see everyone who comes to its Comprehensive Care Center on Mechanic Street, Ware said. Last year, the community mental health center that serves 17 counties in Central Kentucky served approximately 31,000 people, up from roughly 26,000 in 2002.
Ware said Bluegrass is still trying to figure out how they are going to deal with additional cuts in state funding. Its budget was cut by more than $400,000 earlier this year. A 4 percent cut would mean an additional $500,000 cut for Bluegrass.
Ramsey said her clients at Catholic Action Center simply can't depend on the public health system. And it's not just mental health services that have been cut. The county health department pulled a health clinic at the center because of budget reductions earlier this year.
But Ramsey has been fortunate. A group called Paragon Medical Group — which has a non-profit arm — has agreed to see Catholic Action Center clients for both psychiatric and medical care.
It's a good thing, because more and more people are turning to the non-profit Catholic Action Center for help.
"We're seeing a lot of new people that we've never seen before," Ramsey said. "And it's been going on for more than a year and a half."