Case: DOJ Investigation of Kentucky's Mental Health Service System

This case entry summarizes a DOJ investigation into Kentucky's mental health system. On May 24, 2022, the Department of Justice (DOJ) announced an investigation into whether Kentucky subjects adults with serious mental illness living in the Louisville/Jefferson County Metro area to unnecessary institutionalization in psychiatric hospitals, in violation of the Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq. This investigation was separate from the DOJ investigation launched in 2021, which found, among other violations, that the Louisville Police Department had needlessly used police force to respond to behavioral health calls instead of sending medical aid. Specifically, this investigation examined whether Kentucky “unnecessarily segregates people with serious mental illness in psychiatric hospitals and places them at risk of law enforcement encounters by failing to provide integrated community-based mental health services needed to avoid these results.”

On August 27, 2024, the DOJ published a report on its findings. It concluded that the Louisville Metro Police Department and the Louisville Metropolitan Government violated Title II of the ADA by not providing sufficient access to community mental and behavioral health services. As a result, people with mental or behavioral problems were responded to with law enforcement or segregated in psychiatric facilities. Specifically, the DOJ made the following key findings:

1. Adults in Louisville with mental illness experience repeated psychiatric hospitalizations where they are segregated from the rest of their community. This occurs despite the fact that these adults are able and willing to receive help from community-based services. The DOJ concluded that Kentucky does not provide sufficient services and is not properly ensuring access to those services both before and after hospitalization.
2. The lack of community-based mental health services leads to law enforcement being called to deal with mental health crises. This can lead to incarceration for those with mental illnesses. The DOJ found that 16% of all people who had a psychiatric hospitalization in Louisville in 2022 also visited the Louisville jail. On average, people who were admitted to both institutions spend 54 nights a year in either jail or a psychiatric hospital. Such disruption from daily life had the effect of worsening their mental illness.
3. Kentucky as a whole does not meaningfully track the capacity of its community-based services or ensure adequate access to those services. Among the major problems here was that the Kentucky health officials the DOJ interviewed had little understanding of the current utilization of community-based mental health services as well as what needs the system has. In addition, health officials were not in communication with local law enforcement, hospitals, or other state agencies to monitor rates of incarceration or the frequency of repeat hospital visits.
4. Kentucky can reasonably modify its mental and behavioral health system, as is required to avoid disability discrimination. Specifically, the DOJ recommended that Kentucky should ensure that, before and after hospitalization, people have access to services like mobile crisis, crisis stabilization, assertive community treatment, peer support, supported employment, targeted case management, transportation, and individualized community support services. The DOJ also recommended that Kentucky increase funding for permanent supportive housing and create diversion programs to reduce hospitalization and incarceration. 

As of October 2024, there have been no further updates on this case.