How Kentucky’s “Seth’s Law” Reduces Barriers to Care for Competency to Stand Trial and Guardianship
Inside the Kentucky Supreme Court (Photo Credit: Dennis Weiskircher/Flickr)
In April 2024, Kentucky enacted Seth’s Law, landmark legislation designed to resolve a years-long crisis in its competency to stand trial system that had left hundreds of people waiting up to 18 months for an evaluation. By formally authorizing outpatient evaluations and modernizing guardianship procedures, the law represents a major shift from courtroom backlogs to community-based care.
Early results are dramatic: The outpatient evaluation process has already helped decrease the waitlist for competency evaluations by 91% since September 2023, reducing wait times from over a year to just 10 weeks.
This legislative success was the culmination of a multiyear effort that began in August 2022 when the Kentucky Supreme Court established the Kentucky Judicial Commission on Mental Health (KJCMH). The KJCMH was created to bring together courts, the criminal justice system, the state legislature, advocacy organizations, and behavioral health and forensic experts to examine and make recommendations to improve how Kentucky responds to individuals with mental illness, substance use disorder, and intellectual and developmental disabilities.
As part of this effort, the KJCMH created a Competency Workgroup to specifically address challenges in Kentucky’s competency system. The group was charged with examining data, engaging court partners, and implementing strategies to ensure that competency to stand trial procedures are fair, efficient, and connected to appropriate behavioral health supports.
Turning National Best Practices into State Reforms
The Competency Workgroup began meeting in March 2023, supported by technical assistance from The Council of State Governments (CSG) Justice Center. Their charge was to translate national best practices from Just and Well: Rethinking How States Approach Competency to Stand Trial into concrete reforms for Kentucky.
Like many states across the nation, Kentucky has long struggled with the overwhelming demand for competency evaluations. The problem was further complicated by workforce deficits during the pandemic in both the number of qualified professionals who conduct competency evaluations and patient care staff who provide inpatient restoration services. These backlogs not only delayed justice but also prolonged increased costs for jails and uncertainty for defendants, victims, and families.
Recognizing the urgency, Kentucky took decisive steps in 2022 to address the crisis. Courts were encouraged to prioritize outpatient evaluations as a first option rather than defaulting to inpatient admission. This shift was supported through innovative partnerships with correctional facilities, which made it possible to conduct evaluations both in person and via videoconference. By creating more flexibility in the system, Kentucky began to reduce wait times, streamline processes, and provide a timelier response to individuals whose competency was in question.
While this reform reduced wait times for some, overall demand continued to grow. By September 2023, the inpatient waitlist had reached nearly 400 individuals, who often waited 15–18 months for inpatient evaluation and restoration.
Analysis by the Kentucky Correctional Psychiatric Center showed that 67% of people evaluated on an outpatient basis were found competent. This suggested that many individuals were being referred to the competency system primarily to access behavioral health services, rather than because they were truly unable to stand trial. As Just and Well emphasizes, raising a person’s competency is not the same as providing long-term treatment for recovery.
Guided by this data, the Competency Workgroup conducted statewide listening sessions and town halls to engage communities directly. Those conversations informed recommendations that culminated in HB 385 (2024), known as Seth’s Law.
Signed into law in April 2024, Seth’s Law represents a major shift in Kentucky’s approach to competency to stand trial. Named in honor of attorney Seth Stevens, a valued KJCMH member lost to suicide, the law enshrines judicial authority to order outpatient competency and criminal responsibility evaluations for both misdemeanors and felonies.
The law builds on the earlier flexible order by formally embedding outpatient evaluation into statute. This approach mirrors Tennessee’s longstanding process and ensures that courts can tailor evaluations to the individual’s needs, balancing safety with the least restrictive setting.
Modernizing Guardianship for Adults with Mental Illness
Seth’s Law also modernizes Kentucky’s guardianship framework.
Previously, individuals lacking decisional capacity who had no close relatives often defaulted to state-appointed guardians. The new law authorizes a trusted “adult friend” to serve in this role, following a model used in Indiana. This change broadens access to care and decision-making, while reducing unnecessary reliance on state guardianship.
To aid in implementation, the KJCMH has developed a suite of public-facing materials to help courts, practitioners, and the public understand the law’s provisions and how they will be applied.
“Seth’s Law is proof that collaboration works. The Judicial Commission on Mental Health, utilizing data and collaboration, turned years of frustration into measurable change. We are seeing much faster evaluations and stronger connections between our courts and behavioral health partners. The Commission has been the driver behind Kentucky delivering justice with more efficiency, fairness, and compassion.” —Debra Hembree Lambert, Chief Justice, Kentucky Supreme Court
Implementing in Courts and Jails
The focus on outpatient evaluation and restoration reflects recommendations from the National Judicial Task Force to Examine State Courts’ Response to Mental Health, Just and Well, and national judicial leadership bodies such as the Conference of Chief Justices and the Conference of State Court Administrators.
Implementation is already underway.
- For courts, the Competency Workgroup developed new procedures and training for judges, attorneys, and staff on how to apply Seth’s Law effectively.
- For jails, the workgroup partnered with the Kentucky Jailers’ Association to prepare facilities for jail-based outpatient evaluation and restoration. This includes addressing technology needs (computers, tablets, cameras), ensuring internet stability, and providing staff training. A pilot jail-based competency restoration program has been launched at the Louisville Metropolitan Detention Center.
Reflecting on the process, Competency Workgroup Chair Dr. Koleen Slusher emphasized the value of collaboration: “We learned from each other and through that process were able to do things none of us could do alone.”
Looking ahead, the Competency Workgroup plans to continue tracking outcomes, including wait times for evaluations and restorations across settings, as well as the impact of outpatient procedures on both system efficiency and individual recovery.
The significant initial reduction in wait times sets a strong foundation for this next phase of work, which will likely focus on expanding the forensic health care continuum of care to include community-based restoration and expanded jail-based competency restoration where appropriate. Building on the improvements from Seth’s Law, these efforts will improve the efficiency and effectiveness of competency to stand trial processes in Kentucky while demonstrating the commonwealth’s commitment to recovery.
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