Louisville Program Seeks to Help Mentally Ill

The Courier-Journal

By Chris Kenning

They’re severely mentally ill, often homeless and abusing alcohol or drugs. And as a result, many get stuck cycling endlessly in and out of jails, courts and emergency rooms — a patchwork system that’s expensive but often fails to help them overcome their problems.

But now that population is the target of a recently launched Louisville program that provides free housing and assigns a team of 10 people to provide nearly constant care — ensuring they make appointments, take medications, obtain health care, stay sober and avoid jail.

Mayor Greg Fischer joined the jail director, mental health providers, judges and advocates Tuesday to highlight the fledgling Assertive Community Treatment program, part of a move across Kentucky to better aid a long-neglected population and save public money.

Began earlier this year, the ACT program, which costs $21,000 per person each year, has already enrolled nearly 29 people and expects to reach up to 100 in its first year — people who program supporters say already cost taxpayers far more.

“People need to understand we are paying for this illness, either directly or indirectly, right now,” Fischer said. More important, he said, it will help vulnerable residents for whom “for years, we haven’t a solution — that’s not right,” adding, “It’s an important step we’re taking.”

Some said the need was underscored recently by a recent PBS documentary on Kentucky called “Prison State,” focusing on the cycle of incarceration that featured a man who got out of jail but didn’t stay on his medication and wound up back behind bars.

“There’s very little about being in jail that fixes your schizophrenia,” said Tony Zipple, CEO of Seven Counties Services, the area’s mental health provider, which is overseeing the effort.

Funding for the $2 million-plus program became available largely from a settlement reached last year between the Kentucky Protection and Advocacy Division and the Cabinet for Health and Family Services to provide community-based housing to residents in personal-care homes.

That’s funding similar services to 600 people across Kentucky over three years, according to advocacy department officials, who said teams are being set up across the state. Advocates said it’s an important step in a state that has long underfunded mental health treatment.

“We’ve long been concerned about the services or lack thereof for persons with mental illnesses,” said Heidi Schissler, legal director of the Kentucky Protection and Advocacy Division.

Assertive Community Treatment programs were first tried in the 1970s as a way to deinstitutionalize mentally ill patients. And while it’s new to Kentucky, they are now used in states from New York to Michigan. A similar program in Chicago helped reduce participant re-arrest rates by 80 percent.

A key element is having an apartment, provided through vouchers, some from the city and housing authority. A stable residence helps reduce exposure-related illness and anxiety while fostering independence. Clients are less likely to disappear into homeless camps and fall off the radar.

The team, which include a nurse, psychiatrist, social worker and case manager, ensures that clients get counseling, keep social-service appointments, qualify for food stamps, follow substance-recovery plans, clean their homes and shop for food, get bus passes or find work. The voluntary help will continue for an individual client as long as it’s needed.

Zipple said the program is for people with “the most severe” mental illnesses and haven’t been capable of staying out of crisis. The program “allows us to put people’s lives back together, to improve public safety and save taxpayer money,” he said.

One of the new program’s clients is Reggie Jackson, 35, who has schizophrenia but said he’s doing better after leaving a care home and getting help from the team making appointments.

“I believe the program creates a better place for us,” he said.

Louisville Metro Corrections Director Mark Bolton, who along with Zipple has been pushing for the program for some time, said that several months into the program, it has already increased the length of time between re-arrests for some ACT clients. But at a jail where nearly 20 percent of inmates are suffering from a mental illness, the need is still great.

“They’re homeless, they quit taking their medications. They come into the jail … we take care of them, we clean them up, we feed them, we get them back on their medication,” Bolton said. Once out of jail, he said, “their medications runs out. They’re not connected to services … they don’t show up for appointments … and the cycle starts all over again.”

“We have spent hundreds and hundreds of thousands of dollars, if not millions of dollars, on a very select few number of individuals,” he said, noting they plan to measure the results of the program.

Officials hope to expand it next year, hiring a second team and doubling the number of clients it serves.

Jefferson District Judge David Holton, who also has struggled with the problem in his courtroom, said he was heartened the program had launched even during a time of cuts for mental illness services. He called the new program “the right thing to do.”