RespiteMatch.com Health Blog

By Laura Ungar
lungar@courier-journal.com
The Courier-Journal

Citing the unfulfilled promise of Kentucky’s mental-health system, a leading advocacy organization has given the state a failing grade in its first state-by-state analysis of such systems in more than 15 years.

Kentucky is one of eight states to receive an F on the report by the National Alliance on Mental Illness. Indiana posted a D-minus, with the alliance pointing to problems such as waiting lists for community services. The national average was a D.

“Fifteen years ago, Kentucky had the potential for developing one of the best … systems in the nation — and a reputation for innovation,” states the report, to be released today. “Unfortunately, its promise never was fulfilled, due largely to the lack of adequate resources.”

The report says funding for Kentucky’s community mental-health system has been flat for more than a dozen years, and now ranks 42nd in the nation in per-person spending. That amounts to $210 million annually in state, federal and local funds for mental health.

Some Kentuckians affected by mental illness, and those who serve the mentally ill, say the lack of money is hurting some of the most vulnerable citizens and shows that the state doesn’t view mental illness as a high priority.

“Kentucky has a miserable, miserable, miserable record,” said Vernon Lynn Stephens, a 58-year-old Louisville man with bipolar disorder who said he used to work as a psychiatric social worker.

Stephens said he has gone without needed services at times and now worries that he might have to go from seeing his therapist twice a month to once a month, and possibly even less frequently.

State officials acknowledged yesterday that funding has generally been flat but said there have been increases in specific services over the past dozen years.

And Gov. Ernie Fletcher’s proposed budget for 2007-08 includes an increase of $30 million, said Steve Shannon, deputy commissioner for state Mental Health and Mental Retardation Services.

Advocates contend, however, that none of that increase is going to community programs and is instead going to psychiatric hospitals and to create a crisis unit for people with mental retardation and mental illness.

“Clearly we’re disappointed with the grade that NAMI gave us,” Shannon said. “But the next time NAMI does this, we want to be one of those few states to score a B.”

The report found a few bright spots in Kentucky’s system, which served 28,737 adults with severe illness in fiscal year 2005.

It said the state has provided regional centers with funds for emergency and mobile crisis services, residential crisis stabilization units and overnight crisis beds for short-term problems.

It also praised Fletcher for a decision late last year to allocate $5 million over two years in housing money for mentally ill people who are homeless or at risk for homelessness.

And it said a federally funded mental-health court and a police Crisis Intervention Team have helped people into treatment rather than jail.

But the bad outweighed the good. The state’s plan to reform Medicaid could jeopardize access to care for many mentally ill patients, the report says, partly because the plan imposes co-payments for nonemergency care in emergency rooms, where people with serious mental illnesses often turn.

The report also cites a serious and growing shortage of inpatient beds.

“Funding is the issue here,” said Jim Dailey, executive director of the alliance’s Kentucky chapter. “There is money for what we consider our public-policy priorities, and mental health is not a public-policy priority.”

Katharine Dobbins, director of programs for Wellspring in Louisville, said her nonprofit mental-health agency has had to cut staff support for its housing program, which means it can’t serve some people with the most severe disabilities.

Other mental-health professionals and advocates pointed out that Kentucky has only one eight-bed “crisis stabilization unit” for Louisville and six surrounding counties.

Doctors diagnosed bipolar disorder in Liz Torres when she was in her mid-20s. She said she has been lucky to get the services she needs but knows many others who have not.

“It’s pathetic,” said Torres, 51, of Louisville. “So many people are going around without any care.”

Both Kentucky and Indiana officials said they expect to make improvements.

Shannon said Kentucky is making mental illness a priority and hopes to expand its work force and its housing programs for people with mental illness, among other changes.

Mitch Roob, secretary of Indiana’s Family and Social Services Administration, said the Hoosier state has a “transformation plan” for mental health that includes transferring management of mental-health hospitals to local nonprofit organizations.

He said in a statement that he hopes this plan brings Indiana “to the top of the class.”

“We know that past performance was unacceptable,” Roob said.

Reporter Laura Ungar