Kentucky passed Tim’s Law to help mentally ill get treatment. Here’s what went wrong.

Nobody is using a heralded 2017 state law that was intended to help hundreds of Kentuckians with serious mental illness break the perilous cycle of homelessness, jail and involuntary hospitalization, according to court officials.

“Since it’s passed, I don’t recall having a single Tim’s Law case,” Fayette District Judge Kim Wilkie said in a recent interview.

“But we’ve got to get these folks help,” Wilkie said. “We’ve got to get them treatment, we’ve got to get them medication, we’ve got to get them off the streets or else they’re gonna get in trouble.”

After several years of lobbying by mental health advocates, the General Assembly last year overwhelmingly passed Tim’s Law and overrode a veto by Gov. Matt Bevin. The law created a petition process so that district court judges can order seriously mentally ill people, under certain specific conditions, into supervised outpatient treatment, including medication, counseling and enrollment in public assistance.

Bevin said he vetoed Tim’s Law because it would “permit the restriction of liberty for individuals who have not committed crimes and do not pose a threat to anyone.” The legislature disregarded Bevin’s objections, although the Kentucky Department of Public Advocacy warns that it will file a constitutional challenge to Tim’s Law on behalf of people ordered into treatment if the law ever is used.

“These are individuals who have done nothing wrong. They have a mental illness,” the state’s public advocate, Damon Preston said last week. “If someone is living their life and not bothering others, they should be free to do so without the government telling them what to do.”

Tim’s Law is named for Tim Morton, a Lexington man who was hospitalized for psychiatric treatment dozens of times over 36 years, often involuntarily and in police handcuffs, because he did not recognize that he had schizophrenia.

When Morton wasn’t locked in Eastern State Hospital, he spent his days aimlessly wandering the city streets. Until he clearly posed a danger to himself or others — which only happened after he spiraled downward for long enough — there was no legal mechanism for his loved ones to force him into treatment. Morton died in 2014 from long-neglected health problems at the age of 56.

His story, while tragic, wasn’t uncommon. A 2006 study from the U.S. Justice Department found that more than half of prison and jail inmates were mentally ill, as was roughly one-fourth of the homeless population. These were people who had a hard time keeping a job or housing or understanding society’s rules, the study found.

Last year, lawmakers said they hoped Tim’s Law would make a difference for an estimated 2,000 untreated Kentuckians who suffer as Morton did from anosognosia, a failure to recognize that they have severe mental illness. Already, 44 other states had a similar law on the books allowing for “assisted outpatient treatment” in such circumstances, they said.

“I have confidence that, while this is a small step, it’s a step in the right direction. We’re going to be able to help a lot of these folks,” state Sen. Ralph Alvarado, R-Winchester, one of the bill’s sponsors, said at the time.

However, no petitions have been filed under Tim’s Law so far, according to a review of statewide data by the Kentucky Administrative Office of the Courts and interviews with judges in Lexington and Louisville who oversee their cities’ mental health courts.

Part of the problem is a lack of public awareness, court officials said. But the legislature also failed to provide any money for more staff at community mental health agencies or courthouses, or — since respondents are entitled to a lawyer to represent them at hearings — public defender’s offices. All of these state-funded institutions already are struggling with their current caseloads.

In fact, tucked into the nine-page law is a short note stating that it won’t take full effect until “adequate funding” is made available.

“It breaks my heart, it really does,” Faye Morton, Tim’s mother, said last week. “We’re very aware of the lack of interest in this.”

Advocates who fought for the law say continued inaction is unacceptable.

Unless they are compelled to accept treatment, Kentuckians like Tim Morton often find themselves arrested on “nuisance” charges such as trespassing or disorderly conduct. And a jail cell is not the right place for such people, said Kelly Gunning of the National Alliance on Mental Illness in Lexington.

“Would you want cancer patients going to jail to be treated?” Gunning asked. “If you have pancreatic cancer, you don’t go in handcuffs in the back of a patrol car to the jail for your treatment. You’re sick; you go to a doctor. People who are mentally ill are physically sick. Their brains are broken. We know this from PET scans. You don’t deal with that by locking people up in the criminal justice system.”

Under Tim’s Law, a petitioner can swear to a district court that someone has been diagnosed with a serious mental illness, has been involuntarily hospitalized at least twice in the previous 12 months and is unlikely to voluntarily adhere to the treatment they need to remain healthy.

After a hearing and an exam, a judge can order the person into outpatient treatment, with regular progress reports to be made to the court. As a compromise to those concerned about civil liberties, lawmakers drafting the law made it clear that people who disobey an order for treatment will not face contempt of court charges, although they could be held in a hospital for 72 hours for an evaluation.

The real power of Tim’s Law — and in similar laws in other states — lies in “the black robe effect,” Gunning said. People want to please the judges they regularly see in court by making progress with their treatment, even if there isn’t a criminal penalty hanging over their heads, she said.

Mental health courts do something similar, but their participants have been charged with minor crimes that can be diverted through successful completion of a program, while Tim’s Law respondents are not facing charges.

“Ultimately, what’s going to make the difference is knowing that someone cared enough to check up on me and made sure that I was doing what I was supposed to do,” Gunning said. “I won’t want to disappoint people who are making that effort for me.”

Several advocates said Tim’s Law could begin on a trial basis without much cost in existing mental health courts in Louisville and Lexington. These programs already have the staff and resources that would be necessary for a small pool of Tim’s Law respondents, advocates say.

The question, advocates ask, is who will file petitions with the courts under Tim’s Law? Some of the seriously mentally ill do not have responsible adults in their lives ready to intercede.

“The way I see it, the petitions are going to have to be initiated by the hospitals — by Central State and Eastern State — they’re going to have to identify their frequent fliers and then get the process started for us before their patients are discharged from an involuntary stay so we can find a better way to handle this,” said Jefferson District Judge Stephanie Pearce Burke.

“We’re already late to the game on this,” Burke said. “And the thing is, it works in the places where they’re doing it.”

Some studies have shown 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, collectively, they spent less time in hospitals and were more likely to take their medications than other mentally ill people being monitored by the state.

Bluegrass.org, a publicly funded nonprofit that provides mental health services in Lexington, is ready to receive Tim’s Law respondents for treatment, but funding “is very tight” already, said Don Rogers, chief clinical officer. Mountain Comprehensive Care Center, a sister agency in Eastern Kentucky, has a $500,000, four-year federal grant that could be tapped, if anyone in that area ever files a Tim’s Law petition, said project manager Martin Meade.

Gunning said that while it would have been nice if lawmakers provided money, it’s a mistake to put Tim’s Law on hold just because they didn’t. Most of the mentally ill who would be covered by the law are likely to pass through courtrooms with a public defender and require publicly funded mental health care regardless, so it’s better if they are handled under this newer, more humane system, Gunning said.

“Money shouldn’t be the be-all and end-all,” Gunning said. “What’s frustrating is how we’re doing this. Check the recidivism rates of people coming out of Eastern State Hospital.”

She spun an index finger in a circle on the tabletop in front of her.

“Jail. Swish, swish. Hospital. Swish, swish. Jail. Swish, swish. Hospital. It just keeps going,” she said “That’s the cycle we need to break.”