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From YouTube: Severe Mental Illness Task Force (9-21-21)
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A
A
Members
were
provided
a
zoom
link
to
access
the
meeting
remotely
the
meeting
materials
were
put
online
earlier
this
week
and
made
available
for
downloading,
and
at
this
time
I
will
ask
the
secretary
to
please
call
the
members
roll.
Remember
members,
you
need
to
indicate
whether
you
are
present
in
person
or
remote
senator
alvarado
president.
A
We
do
have
a
quorum
and
so
are
duly
authorized
to
do
business
next
up,
I
would
need
if
you
have
perused
the
august
4th
meeting
materials.
I
would
need
a
motion.
B
A
Prunty,
all
those
in
favor
say
aye
aye
all
opposed.
There
is
no
opposition.
I
see
before
we
begin
with
the
presentations
for
members
who
are
presenting
remotely.
Please
remember
to
mute
your
mics
unless
you
are
asking
a
question.
If
any
member
wants
to
ask
a
question,
please
let
our
staff
know
members
participating
remotely.
A
C
Terrific
all
right
so
again,
thank
you
so
much
for
the
opportunity
to
be
here
today
and
talk
to
you
a
little
bit
about
tim's
law.
Well,
I
never
had
an
opportunity
to
meet
tim
morton,
who
is
this
law's
name
for
I've
known
his
mother
faye
morton.
For
many
years
I
was
a
very
active
member
of
nami,
the
national
alliance
for
mental
illness.
C
For
a
number
of
years
before
I
joined
the
cabinet
and
she's
a
very
strong
advocate-
and
I
know
she's
pleased
that
we're
finally
starting
implementation
of
this
important
program,
so
tim's
law,
the
provisions
for
tim's
law,
are
outlined
in
krs-202a
and
were
adopted.
As
you
know,
in
the
2017
legislative
session
it
provides
a
mechanism
for
involuntary
outpatient
treatment,
known
as
aot
or
assisted
outpatient
treatment,
and
the
implementation
of
those
new
provisions
were
contingent
upon
adequate
funding.
So
the
department,
our
department
of
behavioral
health,
has
been
actively
looking
for
funding.
C
Since
that
was
passed,
we
were
awarded.
We
successfully
applied
for
a
competitive
grant
from
samhsa
the
substance,
abuse
and
mental
health
services
administration
and
were
awarded
4
million
dollars
last
july
for
a
four-year
grant.
So
that's
a
million
dollars
a
year
for
four
years
the
services
were
initiated
in
december
of
2020
after
a
few
months
of
planning
and
getting
everything
together.
C
Covid,
I
will
say,
did
slow
us
down
a
little
bit,
but
we
have
since
moved
forward
we're
required
to
serve
192
clients
across
two
regions
over
those
four
years
and
it's
being
implemented
in
two
phases.
We
started
in
december
in
the
central
state
hospital
region
and
that
will
run
the
entire
duration
of
the
grant
and
then
next
year
in
2022
we
will
start
to
provide
services
in
the
western
kentucky
hospital
region.
C
This
map
just
shows
the
locations
of
those
regions
so
you'll
see
in
purple.
That's
our
phase
one
and
there's
a
star
there
that
shows
central
state
hospital
and
they're
served
by
seven
counties:
community
mental
health
center
and
community
care
community
mental
health
center
next
year
in
2022,
we'll
start
in
the
western
state
hospital
region
which
you
see
in
green
two
of
the
communal
health
centers.
C
C
The
grant
objectives
are
pretty
straightforward:
we're
looking
to
improve
the
outcomes
for
qualifying
serious
mental
ill
population
in
the
regions
that
serve.
We
want
to
create
a
sustainable
model
for
statewide
implementation
through
collaboration,
evaluation
and
experience.
We
want
to
be
able
to
demonstrate
cost
savings
that
this
will
cost
less
than
hospitalization
jail
time.
C
Other
adverse
outcomes
costs
that
are
covered
by
the
grant
include
some
of
the
cmhc
staff
that
were
added
and
some
limited
client
support
funds
for
things
like
transportation
and
personal
needs,
and
they
cover
the
cost
of
training,
materials,
development
and
publishing
of
those
materials
and
evaluation
of
the
program
do
note
that
the
treatment
providers
do
are
required
to
build
third
party
payers
for
any
qualifying
services.
So
those
services
are
not
covered
by
the
grant.
C
This
graphic
shows
all
of
our
partners,
our
funded
partners,
so
at
the
top
is
the
cabinet
and
then
samhsa
again,
that's
our
funder.
That's
where
the
grant
money
came
from
in
the
middle
you'll,
see
the
four
currently
funded
community:
mental
health,
centers,
communicator,
7
counties,
penny
royal
and
river
valley
and
then
at
the
bottom.
C
C
C
The
the
the
evaluation
itself
is
actually
initiating
the
state
hospital,
and
you
know
I
participated
in
part
of
the
process
when
the
language
was
written
and
that
wasn't
the
original
intent,
but
how
it's
being
rolled
out
is
within
the
statute,
and
it's
working
very
well,
because
we
know
the
people
that
are
being
referred
to
meet
criteria
and
have
recently
had
a
crisis.
C
C
The
cmhc
can
order
an
array
of
services
in
that
treatment,
plan
therapy,
medication,
housing
support
they
can
attend
a
physical
health
care,
needs,
vocational
skills
development
and
they
collaborate
with
law
enforcement,
family,
other
stakeholders,
just
a
whole
number
of
people.
C
One
thing
that
we've
really
picked
up
on
really
quickly
with
this
project
is
that
communication
is
key
communication
communication
communication.
We
spend
a
lot
of
time
on
that,
getting
all
the
stakeholders
talking
to
each
other
and
making
sure
we're
serving
the
best
interests
of
the
client
and
working
towards
good
outcomes
for
them.
C
Some
of
the
clients
do
get
assertive
community
treatment
or
act
services.
I
know
we
get
asked
about
that
a
lot,
but
not
everybody
it
it's
pretty
pervasive,
but
not
everybody
gets
that
each
step
of
the
court
and
treatment
process
are
geared
towards
the
individual's
needs
and
the
judge
really.
The
judge
can
adapt
their
role
to
be
supportive,
instructive
or
an
authoritarian.
C
It
really
is
what
motivates
each
individual
patient,
and
so
we
see
that
kind
of
shift
we're
looking
at
a
number
of
measures
to
determine
if
this,
if
this
is
effective
on
the
individual
level,
we're
looking
at
impact,
not
just
participation
not
do
they
show
up.
But
what
are
the
actual
outcomes
so
hospitalization
days
jail
days,
homeless,
days,
use
of
the
emergency
departments?
Medicaid
utilization?
C
Are
they
satisfied
with
the
service?
Do
they
report
substance,
use
and
there's
a
excuse
me,
an
assessment
when
they're
first
entered
into
the
program
and
then
a
six-month
reassessment
to
see
how
they're
doing
some
of
those
same
measures
are
being
used
to
evaluate
the
program
overall.
So
again
that
would
be
psych
hospital
days,
jail
days,
homelessness,
emergency
room
utilization,
medicaid
utilization
and
then
we're
also
working
towards
a
cost
benefit
analysis.
C
This
is
some
client-specific
debt.
I
know
it's
pretty
small
again.
We
only
started
in
december
and
this
data
is
just
for
the
first
six
or
seven
months,
so
it
goes
through
sometime
in
june.
So
you
can
see
at
the
initial
assessment.
C
This
shows
18
people
who
have
been
admitted
we've
added
another
one.
Since
this
data
was
formed
for
19,
there
have
been
20
referrals
all
together
and
only
one
of
those
folks
didn't
meet
criteria,
and
that
was
very
early
on
everybody
has
since
really
gotten
in
tune
with
what
the
criteria
are.
You
can
see
about
the
most
are
male,
so
13
of
the
18,
the
majority
fall
between
the
ages
of
26
and
54.,
two-thirds
white
one-third
black.
So
there
is
a
bit
of
disparity
so
far.
C
C
So
only
at
the
time
this
data
was
collected,
only
four
clients
had
come
to
the
six
months
and
and
of
no
nobody's
dropped
out.
So
we've
got
four
who
went
all
the
way
through
and
there's
some
demographics
here
and
and
you'll
know
it.
The
number
for
race
and
ethnic
adds
up
to
five.
That's
not
a
mistake.
People
can
check
more
than
one
box.
So
that's
what
happened
there
what's
important
here,
I
think,
is
the
client
status
at
the
end.
C
C
There
was
only
one
arrest,
but
please
know
that
that
was
for
criminal
activity
that
occurred
prior
to
coming
into
the
aot
program.
So
there
was,
there
were
no
new
arrests,
no
no
jail
that
was
affiliated
or
associated
with
anything
that
happened
during
those
six
months
that
they
were
part
of
the
program
and
all
four
respondents
indicated
that
they
had
improved
crisis
and
recovery
support
that
they
were
effectively
dealing
with
their
problems
that
they
always
are
usually
were
taking
their
medications
and
staff
believed
in
their
recovery.
C
Okay,
again
just
a
little
bit
about
aot
cost,
so
I
talked
a
little
bit
about
what
it
covers.
I'm
going
to
spend
a
minute
on
what
it
doesn't
cover,
so
there
are,
of
course,
costs
associated
with
the
team
in
general
right.
The
staff,
which
will
usually
include
a
coordinator,
a
targeted
case
manager,
sphere,
support
specialists,
other
clinicians
of
clinical
support.
Of
course,
there's
operating
costs
like
reporting
and
oversight,
office,
space
supplies,
human
resources,
fiscal
support,
training
and
certification.
C
The
piece
that's
a
lot
more
difficult
are
the
client
support
funds
and
those
are
really
more
challenging
to
identify
that
includes
things
like
housing,
which
I
know
you
hear
a
lot
about
transportation.
There
are
certain
medications
and
medical
services
and
then
just
personal
items
that
aren't
necessarily
covered.
C
You
specifically
asked
for
future
implementation
recommendations
and,
as
I
said,
we
don't
have
a
lot
of
data
here
in
kentucky,
but
we
know
from
what
we
know
from
across
the
country
is
that
aot
works?
It
works
for
a
lot
of
people,
and
so
we
would
recommend,
albeit
perhaps
prematurely,
that
we
this
should
be
expanded
throughout
the
state
to
all
our
state
hospital
and
cmhc's
regions.
C
But
we
would
recommend
that
this
be
very
incremental
that
that
we
take
this
at
a
pace
where
we
can
make
sure
it's
done
right
and
that
the
everybody
has
the
support
they
need.
We
can
provide
the
education
and
so
on.
This
pilot
project
is
specifically
designed
to
help
reveal
a
path
forward
as
far
as
what
resources
are
needed.
C
The
cmhcs
would
need
resources
for
those
components
that
aren't
covered
by
medicaid
or
other
payers
and
then,
as
I
said,
there's
other
stakeholders
that
are
going
to
have
costs
and
oversight
burden,
such
as
administrative
office
of
the
courts,
department
of
public
advocacy,
the
prosecutors
and
others
that
I
haven't
listed
here.
C
I
just
wanted
to
make
a
note
that
you
may
hear
from
other
stakeholders
about
possible
suggestions
to
change
some
of
the
scheduling
language
in
krs.
I'm
not
prepared
to
testify
in
those
details,
but
I
know
that
some
of
the
timelines
have
proven
a
little
bit
difficult
for
some
of
our
other
stakeholders.
C
C
Yes-
and
I
also
have
with
me-
tanya
dickinson
who's,
the
grant
administrator,
so
she's
also
available
to
answer
questions.
Wonderful.
A
We
have
representative
bentley,
who
is
the
co-chair
of
the
committee
with
us
remotely
and
I'm
not
sure
but
representative
bentley.
If
you
have
any
questions,
please
make
us
aware:
okay
at
this
time,.
G
G
Thank
you,
madam
chair,
and
thank
you,
commissioner
morris
for
your
presentation.
I
know
that
the
number
is
very
limited,
but
it
does
appear
that
this
program
has
a
great
deal
of
potential
for
us.
I
remember
when
we.
G
I
remember
when
we
passed
this
legislation,
a
lot
of
excitement
about
it
because
a
dire
need
for
it
and
I'm
glad
to
see
that
the
initial
indications
are
it's
going
to
be
a
strong
program
for
us,
but
a
little
bit
bewildered
a
little
bit
puzzled
as
to
why
we've
there's
so
few
people
in
this
initial.
G
Like
would
you
call
it
a
pilot
program,
but
again,
I
would
think
that
the
universe
for
this
is
substantially
larger
than
what
this
would
indicate
and
are
there
some
barriers
to
implementation
this
program?
Are
you,
do
you
have
some
players
that
really
don't
embrace
it
or
are
we?
Is
there
a
lack
of
resources,
or
can
you.
C
Well,
I
don't
think
we
anticipated
it
to
be
hugely
different
than
this
again
we're
looking
to
serve
192
people
over
four
years.
That's
about
50
people
a
year.
We
only
started
in
december
and
we
had
a
very
slow
start
because
of
covid
and
we're
only
in
one
region.
So
I
think
that
what
you'll
see
is
as
the
grant
progresses.
Those
numbers
will
pick
up
as
we
expand
our
geographic
area
right
now,
we're
in
the
central
state
region
which
is
located
in
louisville.
C
There
happen
to
be
a
lot
more
resources
there
for
people
with
smi,
so
that
could
also
be
a
contributing
factor.
We
also
at
the
the
timsley,
isn't
the
only
way
for
people
to
have
a
commitment
to
outpatient
services.
Central
state
hospital
has
been
our
one
hospital.
That's
been
historically
been
pretty
good
about
using
the
voluntary
outpatient
commitment,
so
they
actually
discharged
quite
a
few
people
on
a
voluntary
commitment
which
doesn't
have
some
of
the
same
provisions
as
tim's
law.
C
There's
not
follow-up
in
the
court
and
some
of
the
other
pieces
to
it,
but
we've
seen
that
grow
pretty
significantly,
as
part
of
as
this
program
has
gone
implemented.
We've
seen
their
numbers
of
voluntary
outpatient
commitments
go
up
as
well.
G
That
certainly
is
encouraging.
Do
you
have
a
a
projected
timetable
as
to
when
this
may
be,
for
one
of
a
better
term,
fully
implemented.
C
Well,
the
pilot
goes
until
2025.,
so
obviously
fully,
as
I
said
before,
it's
contingent
on
funding
for
the
statute.
So
that
would
be
you
know
one
factor,
but
we're
learning
a
lot
and
our
data
is
pretty
limited
now,
but
every
quarter
we
get
a
new,
a
new
data
batch,
so
we'll
we'll
have.
C
Our
next
report
will
be
in
early
november
and
then
there'll
be
another
report
in
early
february,
and
I
expect
that
that
report
in
february
to
probably
paint
a
lot
clearer
picture,
and
we
should
have
a
better
idea
about
what
the
real
cost
will
be
again
for
this
region.
I
think
western
state
will
want
to
do
com
some
comparisons
between
the
regions,
because
it's
more
rural,
they
have
less
services
there.
Their
history
with
using
the
voluntary
outpatient
commitments
is
not
as
strong,
so
I
think
it's
going
to
look.
G
C
I
don't
think
I'm
prepared
to
do
that
today,
but
that
is
absolutely
something
we're
working
towards,
because
we
know
that's
important
to
the
committee
and
a
lot
of
other
stakeholders
so
that
that
that
cost
benefit
analysis
that
we're
asking
uk
to
do.
I
should
yield
some
of
that
information.
G
It
is,
and
obviously
our
first
interest
is
making
sure
that
the
patient
gets
the
quality
of
service
that
they
need
in
a
timely
manner,
but,
as
you
can
guess,
while
we're
in
the
interim
session
we're
hearing
from
a
lot
of
different
people
about
the
need
for
funding,
particularly
it
comes
to
them
to
health
services,
and
I'm
only
always
interested
in
things
that
can
generate
a
return
on.
Our
investment
looks
like
this
potentially
can
so
I
just.
E
G
To
make
sure
we're
tracking
that
strongly
and
that
you
know
whatever
programs
are
impacted
by
that.
If
there
is
a
reduction,
then
we
should
make
those
adjustments
accordingly,
but
appreciate
your
testimony
appreciate
the
information.
Thank
you,
madam
chair.
D
Thank
you,
madam
chair,
and
thank
you
for
your
report.
Actually
senator
meredith
asked
my
questions,
but
I
just
want
to
thank
you
and
I
look
forward
to
the
work
coming
to
the
western
part
of
the
state
which
I
represent.
So
thank
you.
Yes,
thank
you,
madam
chair
senator.
B
Thank
you,
commissioner.
Thank
you,
madam
chair.
Thank
you,
commissioner.
I
know
we
passed
tim's
law
and
I
think
it
was
in
2017.
If
I'm
not
mistaken
right,
that's
the
year
that
was
remember,
that
was
people
were
very
excited,
taking
a
while
to
get
that
bill
across
the
finish
line.
So
it's
been
in
place
for
four
years
or
maybe
a
little
bit
roughly
four
years.
B
C
Not
not
until
we
got
funding
was
it
really
used.
They've
been
they
had
a
similar,
some
semblance
of
a
grant
in
the
far
eastern
part
of
the
state
mountain,
but
it
really
well.
I
won't
go
into
it,
but
it
was
different,
but
really
as
far
as
the
the
actual
implementation
of
tim's
law.
That
just
happened
with
this
grant.
To
the
best
of
my
understanding.
B
In
four
years,
that
was
what
I
wanted
to
know.
I
just
I
remember
seeing
I
think
was
in
2019.
I
saw
an
article
saying
that
someone
had
applied
for
it
in
jefferson
county
and
then
I
don't
think
I'd
ever
saw
anything
else
as
far
as
coverage.
So
that's
what
I
was
curious
about
is
how
many
people
have
actually
utilized
this.
If
it's
just
one
or
two.
Thank
you.
Thank
you,
madam
chair
yeah,.
A
Senator
alvarado,
in
our
notes,
for
today
there
are
some
numbers
there.
I
think
you
had
to
step
out
of
the
room,
but
there
are
some
numbers
page,
nine
of
okay.
Are
there
any
more
questions
to
come
before,
commissioner?
A
E
You
very
much
thank
you,
so,
commissioner
morris.
Thank
congratulations
on
the
samsa
grant
and
I
know
we
really
couldn't
get
this
up
and
running.
You
couldn't
get
this
up
and
running
until
it
was
funded,
and
that
was
you
know
basically
written
into
the
law
that
you
know,
as
funding
is
available,
I
think
was
the
terminology
or
something
similar.
C
I
think
that's
a
really
good
question
and
I
think
again,
we'll
know
more
as
the
data
rolls
in
we
have
sufficient
funding
for
what
we're
doing
right
now.
We
believe
we
are
likely
to
have
sufficient
funding
for
the
next
year
it
it
might
be
by
the
third
year
that
we
really
may
have.
C
There
may
be
a
need
for
additional
funding,
but
that's
again
I
I'm
happy
to
submit
to
the
committee
or
or
share
with
whoever
might
have
an
interest
in
the
data
as
it
comes
in
quarterly,
because
I
think
that's
going
to
be
very
telling,
but
right
now
it's
very
promising.
I
I
actually
had
a
conversation
with.
I
know
many
of
you
know
phil
and
kelly
gunning
last
night,
just
to
make
sure
they
knew
that
I
was
testifying
today
and
to
share
with
them
some
of
the
initial
results.
C
C
The
most
striking
thing
about
the
data
is
that
the
clients
are
happy
with
the
service
and
that
that
means
that,
even
though
it's
involuntary
they're
getting
something
out
of
it-
and
I
think
that's
why
it's
working
is
because
the
approach
that
we're
taking
and
so
I'm
I'm
proud
of
the
work
that
the
team
there
at
central
state
region
and
seven
counties
are
doing
and
the
justice
system
and
communicator
and
everybody
that's
involved-
is
really
committed
to
making
this
work.
E
C
A
I'd
like
to
pause
just
a
second
and
see
if
there
are
any
more
questions
that
people
want
to
ask
that
are
coming
in
virtually
sometimes
we
there's
a
little
bit
of
communication
lag
when
we're
we're
trying
to
do
this.
Well,
if
not,
I
really
appreciate
you
being
here
today.
I
want
to
thank
you
for
rolling
this
out
the
implementation
of
it.
I
got
here
in
1999,
I
think
in
1998
I
went
with
a
friend
to
a
nami
meeting.
F
A
A
Next
on
the
agenda,
we're
going
to
hear
we
hope
from
dr
alan
brinsle.
He
is
the
clinical
director
with
the
kentucky
department
for
behavioral
health,
developmental
and
intellectual
disabilities.
A
H
Excellent,
well,
it's
my
pleasure
to
be
here.
As
you
mentioned,
I'm
alan
brensel.
I
serve
as
the
medical
director,
or
sometimes
known
as
the
clinical
director
for
the
department
of
behavioral
health,
developmental
and
intellectual
disabilities.
So
I
work
in
commissioner
morris's
office.
I've
served
in
that
role
now
for
11
years,
I'm
also
a
faculty
member
at
the
university
of
kentucky,
I'm
a
psychiatrist,
adult
and
child,
as
well
as
a
pediatrician,
and
so
I
have
worked
in
state
government
at
some
capacity
now
for
26
years
so
happy
to
be
here.
H
To
talk
to
the
committee
appreciate
the
interest.
I
know
it's
a
distinguished
committee.
Looking
at
the
membership,
you
have
a
lot
of
direct
experience
in
health
care,
hospital
administration,
pharmacy
and-
and
we
know
I
live
in
your
district.
You've
done
a
long
history
of
advocacy
around
this
population.
So
so
we're
grateful,
and
so
my
goal
is
to
talk
to
you
today
about
our
hospital.
So
I'm
going
to
share
my
screen.
I
hope,
given
that
technology
doesn't
deserve
us.
H
Super,
I
I
don't
see
it
so
I'm
not
sure
why
I
can't
see
it,
but
I
will
we'll
go
from
there,
but
but
again
are
my
slides,
advancing
I
for
some
reason
I
can't
see
my
slides.
H
All
right,
let
me
I
may
need
some
any
controls.
No,
are
they
advanced?
If
I
hit
this
button,
do
they
advance?
Maybe
I
have
to
put
the
cursor
over
here.
I
actually
got
it.
Sorry
I
apologize.
Are
they
advancing?
Yes,
all
right,
so
sometimes
it's
important
to
remember
where
you've
been
when
you
talk
about
hospitals
and
so
we're
not
doomed
to
repeat
the
past,
but
I
think
most
of
you
are
familiar
that
we
have
a
long
storied
history
in
kentucky
of
operating
multiple
state
facilities.
H
These
are
some
pictures
that
I
think
are
of
historic
interest.
The
one
on
the
top
right
is
lakeland
that
that
is
the
former
central
state
hospital
for
those
of
you
who
live
in
louisville.
That
is
now
tom
sawyer
state
park
primarily,
and
we
built
a
replacement
facility
known
as
central
state
hospital
eastern
state
is
in
lexington,
and
that
was
one
the
second
oldest
hospital
in
the
united
states
operating
to
serve
this
population.
H
It
is
now
a
beautiful
bctc,
campus
and
I'll
show
you
our
new
facility
for
eastern
state,
but
just
out
of
historic
interest,
the
one
on
the
bottom
right,
that
is,
the
feeble-minded
institute
of
kentucky,
and
that
is
a
building
that
is
part
of
the
chfs
building
here
across
from
the
cemetery
and
still
in
existence.
And
then
western
state
at
the
top
is
actually
still
open
and
it
has
a
gorgeous
historic
dome
and
is
a
fascinating
building.
H
Just
very
briefly,
we
do
have
four
state
hospitals
and
then
an
additional
forensic
hospital
which
we
won't
discuss
today,
but
we
have
central
state
in
louisville,
and
this
shows
you
the
size
that
they
are
on
on
a
given
basis.
So
central
state
has
on
any
given
day
an
average
of
around
50
to
60
patients.
Western
state
and
hopkinsville
has
around
1920
and
then
state
owned
and
contracted.
As
I
mentioned,
uk
healthcare
operates,
eastern
state
runs
about
125-127,
and
then
we
have
a
partnership
with
arh
and
hazard
in
their
census.
H
In
three
regional
programs
now
runs
at
about
77
individuals.
So
you
can
see.
This
is
a
far
cry
from
the
day
of
those
facilities.
I
showed
you
before
some
of
those
facilities
had
over
2
000
individuals
in
each
of
them,
so
there
was
a
day
prior
to
the
1960s.
Where
kentucky
had
you
know,
four
or
five
thousand
people
that
lived
in
our
institutions,
and
so
kentucky
was
a
leader
in
moving
to
de-institutionalization
of
individuals
in
the
1960s.
Our
community
mental
health
movement
was
one
of
the
premier
movements
in
the
united
states.
H
People
came
from
all
over
the
country
to
be
part
of
that
movement,
and
I
think
we
could
talk
about.
You
know
one
of
the
things
I
wanted
to
possibly
call.
This
talk
is
living
up
to
the
promise
of
de-institutionalization,
because
we
did
move
a
lot
of
people
from
hospitals
and
we
moved
them
because
we
had
new
tools.
H
H
That's
considered,
okay
in
terms
of
violating
people's
rights,
so
I
think
you
all
ask
a
little
bit
about
our
hospital
budgets,
and
this
is
not
my
forte,
but
what
you
can
see
here
is
a
three-year
trend
of
expenditures
for
each
of
the
hospitals
other
than
arh,
which
is
funded
differently
in
that
it,
because
it
is
a
distinct
part
of
a
regular
med,
surg
hospital
and
eligible
for
medicaid
reimbursement.
But
you
can
see
generally,
these
are
flat
line
numbers,
but
it
does
cost
a
lot
of
money
to
operate
at
hospitals.
H
Hospitals
are
expensive,
they
require
licenses,
they
require
clinical
staff
fire
doors
pharmacy,
and
so
it
is
a
lot
of
money
on
a
small
percentage
of
the
smi
population,
but
a
very
important
percentage,
and
so
this
is
a
little
more
detail
about
where
those
funds
come
from.
There's
a
long
history
of
something
called
the
imd
exclusion
which
I
assume
you've
heard
about,
but
when
medicaid
was
created,
it
was
not
intended
to
fund
state
psychiatric
hospitals
or
care
for
those
folks
in
long-term
care,
and
so
it
was
restricted.
H
Any
facility
that
was
predominantly
serving
those
with
mental
illness
was
not
eligible
for
medicaid
reimbursement,
and
so
generally
we
have
funded
those
historically
with
state
general
funds
appropriated
by
your
selves,
to
serve
those
kentuckians
in
need
of
this
level
of
care.
We
do
receive
some
federal
funding
through
the
disproportionate
share
provisions
of
medicaid.
H
We
now
do
or
see
receive
some
small
amount
of
funding
from
managed
care
organizations
for
people
who
stay
a
very
short
amount
of
time
and
then
some
other
payers
there
as
well,
and
if
you
have
questions
about
funding
deputy
commissioner
cray
craft
is
here
and
at
the
end
she
could
answer
questions
who
we
serve
in
our
hospitals.
We
primarily
serve
individuals
who
are
on
involuntary
civil
commitments,
so
we
have
very
few
voluntary
patients.
H
Those
are
served
in
our
community
hospitals,
the
private
sector
and
and
other
facilities
that
that
can
care
for
those,
and
so
we
primarily
serve
individuals
who
are
involuntary
committed
under
the
statute.
We
refer
to
as
202a,
and
that
statue
requires
the
person
to
have
a
mental
illness
to
be
a
danger
to
themselves
or
others.
They
cannot
be
cared
for
in
a
less
restrictive
environment
and
they
have
to
be
able
to
benefit
from
hospitalization
the
thing
about
that
law.
H
Is
it
verily
clearly
states
that,
as
soon
as
a
person
no
longer
meets
those
criteria,
if
they
choose
to
be
with
discharge,
we
are
required
to
discharge
them
by
current
law
and
just
a
couple
of
other
caveats
about
our
hospitals.
We
do
not
operate
at
the
state
level
directly.
Facilities
for
substance
use
disorder
as
the
primary
diagnosis,
so
those
are
again
cared
for
by
our
ever
burgeoning
and
growing
sud
treatment
provider
community
and
we're
grateful
for
our
community
providers
for
substance
use.
H
We
do
not
serve
individuals
with
intellectual
disabilities
if
their
need
is
just
care
for
their
intellectual
disabilities.
However,
if
they
have
a
coexisting,
mental
illness,
they
may
be
eligible
to
be
served
and
may
need
mental
health
treatment
just
like
any
other
citizen,
and
so
we
would
serve
those
and
just
a
caveat.
Kentucky
does
not
operate
as
a
status
as
state
any
mental
hospital
for
children
or
adolescents.
H
This
just
is
a
10-year
trend
of
number
of
admissions
on
an
annual
basis
by
each
of
those
facilities,
and
basically
the
number
in
tells
you
the
totals,
and
so
you
can
see
that
we
serve
about
2
000
people
2100
in
2011,
and
we
we're
we
serve
about
1700
in
2021
and
that
and
that
again
is
total
number
not
at
any
given
time
but
served
over
the
year.
H
That
is
a
substantial
decrease.
We
can
talk
about
why
that
might
be,
but
again
not
the
not
the
trend
we
saw
in
the
decrease
from
the
60s
and
pre
1960s,
but
but
we
do
serve
about
now.
I
think
you
all
have
heard
testimony,
but
we
estimate
there's
about
82
000
individuals
with
smi
in
kentucky,
and
so
you
can
see
hospitals
serve
only
a
small
proportion
of
those
individuals
who
might
be
deemed
as
smi,
but
we
do
serve
about
1700..
H
This
is
that
average
daily
census
that
I
mentioned
in
that
slide.
Some
of
our
hospitals,
central
state,
really
averages
about
50
individuals,
eastern
and
western,
are
closer
to
110
120,
but
about
only
about
83
per
facility
on
any
given
day
in
2021.
H
These
are
the
links
to
stay
and
that's
very
important,
to
think
about
average
length
to
stay.
That's
that
green
line
in
the
middle
is
about
16
days,
and
that
is
a
far
cry
from
the
days
when
you
cross
the
threshold
and
you
never
left,
and
you
were
basically
hospitalized
for
life,
so
we
basically
operate
acute
psychiatric
facilities
for
stabilization
of
individuals
with
smi
who
require
hospitalization.
H
We
do
have
some
outliers
that
stay
90
365
days.
We
have
many
folks
who
stay
three
to
seven
days
and
are
returned
to
care
in
the
community.
There's
a
western
and
central
tend
to
have
a
little
bit
longer
length
of
stays.
Arh
tends
to
have
the
shortest
length
to
stay.
H
This
is
the
diagnosis
of
those
we
serve.
You
look
at
the
definitions.
I
think
you'll
all
have
talked
about
smi,
but
typically
we're
talking
about
individuals
with
thought
disorders
like
schizophrenia,
which
is
about
29
of
them
and
then
affective
or
mood
disorders,
which
include
bipolar,
is
about
another
27
and
then
a
comorbid
about
23
might
have
a
substance
use
disorder,
but
it's
primarily
severe
mood
disorders
and
severe
schizophrenia
and
other
thought
disorders.
H
And
so
basically,
if
you
look
at
2021
about
10
or
11,
came
back
within
30
days,
and
that's
that
does
not
make
us
happy.
That
is
not
what
we
like
to
see
and
we
look
we'll
talk
about
some
of
the
factors
that
where
how
that
might
be
related,
but
it
goes
on
up
to
as
high
as
you
know,
25
within
a
year
within
180
days
return.
H
It
shows
you
the
challenges
we
have
because
many
will
be
stable.
Leave
the
hospital
go
to
the
community,
perhaps
not
stay
in
treatment
or
deteriorate
due
to
other
variables,
and
so
what
we
don't
like
to
see
is
what
we
call
the
revolving
door
phenomenon
right
where
folks
are
admitted
released
to
the
community
returned
to
the
hospital.
H
This
is
a
we
track
to
see
what
percentage
of
individuals
leave
our
hospitals
get
seen
in
an
outpatient
setting,
and
I
will
have
to
say
predominantly
these
folks
are
served
by
our
community
mental
health
centers,
and
so
we
can
contractually
require
them
to
see
our
hospital
discharges
within
14
days
of
release,
and
so
they
will
schedule
them
and
about
50
of
them
will
show
up
for
any
follow-up
within
within
14
days
that
orange
bar
in
2021
for
central
state.
There
is
a
data
issue
we,
the
number
of
admissions,
is
not
accurate.
H
Therefore,
the
number
of
follow-ups
was
not
accurate
and
I
could
not
get
that
corrected,
but
central
is
about
the
same
as
the
others
throughout
all
the
previous
years,
and
I
would
anticipate
that
it's,
but
it's
a
disappointing
number
and
something
to
talk
about
what
what
we
can
do.
This
is
just
to
remind
you
that
this
community
mental
health
centers
are
our
key
entities
for
that
follow-up,
and
each
of
our
hospitals
has
a
catchment
area
where
they
admit
patients
from
that
specific
region.
H
Therefore,
they
develop
relationships
with
those
community
mental
health
centers
and
often
they
are
their
patients,
and
so
they
know
them
before
the
admission,
but
sometimes
the
first
time
we
see
somebody
is
when
they
get
hospitalized.
Therefore
they're
a
new
patient
to
that
community
mental
health
center.
H
After
they
leave
the
hospital
that
is
called
a
warm
hand-off
in
our
our
in
in
our
terminology,
you
know
those
other
tools
we've
talked
about
and
down
on
the
list
are
the
agreed
order,
the
voluntary
outpatient
commitment
and
tim's
law
for
some
of
those
individuals,
but
the
vast
preponderance
of
our
folks
who
leave
you
know.
We
believe
that
voluntary
care
and
voluntary
follow-up
are
are
the
most
effective
long-term.
H
H
H
That's
why
we
often
drive
people
from
the
hospital
to
their
first
appointment
on
the
day
of
discharge
in
some
of
our
hospitals,
particularly
central
state,
that
ensures
they
at
least
make
that
first
appointment
they
get
enrolled
in
follow-up
care.
They
meet
their
provider,
they
know
who
they're
going
to
see.
They
know
the
drill,
they
know
the
door
to
go
through.
H
We've
talked
about
a
little.
I
think
you
all
have
talked
about
assertive
community
treatments,
and
that
is
a
really
key
tool.
We,
we
don't
need
to
be
sitting
in
our
office
waiting
for
these
folks
to
come
to
us.
We
need
to
be
going
out
and
finding
them
and
and
engaging
them
where
they
are
and
ensuring
they
have
the
resources
to
get
the
follow-up
care.
And
so
we
do
fund
assertive
community
treatment
teams
in
each
of
our
cmhc
regions
and
we'll
talk
about
the
challenges
we
have
in
establishing
those
and
maintaining
those.
H
Most
of
our
folks
are
medicaid
eligible,
and
so
they
have
our
managed
care
companies.
All
six
should
have
care
coordination
for
the
folks
who
are
eligible,
and
typically
those
are
folks
who
are
hospitalized,
and
so
we
invite
the
mcos
to
attend
our
discharge.
Planning
meetings,
particularly
for
complicated
patients.
Who've
had
frequent
admissions
so
that
they
can
engage
them
and
you
and
utilize
their
core
care
coordination.
Efforts
to
get
folks
through
any
hurdles
that
might
be
there
mention
tim's
law
is
a
for.
H
A
small
number
will
be
a
valuable
tool
for
those
who
again
at
discharge.
Don't
have
the
insight
or
part
of
their
pathology
is
resistance
to
follow-up
and
then
making
sure
we
get
folks
who
really
need
substance,
use
treatment
to
substance
use
treatment
which
is
really
much
much
more
available
now,
because
if
they
relapse
in
their
substance
use,
then
their
mental
health
condition
likely
deteriorates
as
well.
H
So
so
some
of
the
challenges
so,
as
I
mentioned
most
folks,
are
in
our
hospitals
against
their
will,
and
so
very
often
they
don't
want
to
be
there
and
therefore
they
don't
want
to
go
to
follow-up.
So
that's
one
of
the
challenges.
We
face
when
you
serve
a
population
that
part
of
their
pathology
is
to
be
paranoid
about
the
medicines
paranoid
about
what
people
are
trying
to
do
with
them.
H
They
don't
yet
they
haven't
recovered
to
the
degree
to
have
enough
insight
to
know
they
need
their
medications
and
and
need
the
support,
and
so
that
that's
part
of
what
we
face.
Transportation
is
a
huge
barrier.
I
think
that's
been
alluded
to
by
several
of
folks.
Who've
testified,
and
I
know
it's
an
interest
to
the
committee,
but
I
will
tell
you
one
of
the
major
challenges
and
I
and
where
I
sit
I
advocate
for
consumers.
H
Folks,
we
can
create
a
robust
continuum
of
care,
but
if
a
person
does
not
have
a
place
to
lay
their
head
at
night,
it
is
almost
impossible
to
serve
them
and
use
our
evidence-based
interventions
to
stabilize
them,
and
so
I
do
applaud
the
efforts
and
I
think
you're,
going
to
hear
from
some
of
my
colleagues
in
medicaid
about
how
do
we
use
resources
to
stably
house
folks
and
provide
a
residential
benefit,
because
it's
the
saddest
conversation
I
have
is,
is
that
folks
have
burnt
all
their
bridges.
H
Their
families
are
unable
to
care
for
them
or
they
don't
have
contact
with
their
families.
They
they
don't
have
stable
housing
and
I'm
going
to
show
you
a
percentage
of
folks
who
we
discharge,
who
might
even
go
to
shelters
which
again
are
not
trauma-friendly
settings.
It's
where
you
have
difficulties,
keeping
people
stable,
and
then
I
mentioned
act
teams
and
act
teams
right
now.
One
of
the
things
we're
struggling
with
is
fully
staffing
them
and
then
deploying
them
across
rural
regions
is
expensive.
H
H
So
one
of
the
challenges
we
have
is
many
people
with
smi
present,
while
they're
covered
with
private
insurance,
it's
not
until
their
condition
deteriorates
or
they
lose
their
employment
because
of
their
illness
that
they
then
become
medicaid
eligible.
We
we
can't
let
people
deteriorate
that
far
before
we
had
they
have
access
to
these
services,
and
so
this
is
what
I
promised
you
about.
Where
do
people
go
when
they
leave
our
hospitals,
about,
two-thirds
of
them
go
home
and
home
is
either
their
own
home
or
home
with
family
and
but
about
eight
percent.
H
Go
to
a
mission
setting,
which
is
our
database
terminology
for
emergency
shelter?
Really,
and
that's
a
number,
we're
all
embarrassed
about
and
all
very
upset
about,
and
we
we
work
diligently
to
avoid
that.
But
if
people
choose
to
leave
and
if
we
can't
legally
hold
them,
we
do
facilitate
them
going
at
least
to
a
setting
where
they'll
have
a
roof
over
their
head.
H
Personal
care
homes
are
another
topic
for
us,
but
at
this
point
you
know
we
have
concerns
about
many
of
those
as
well.
We're
under
some
federal
scrutiny
around
the
fact
that
that
might
be
considered
inappropriately
segregating
and
congregating
people
with
disabilities
and
whether
they
folks
would
choose
to
live
there
or
whether
they're
being
offered
the
chance
to
live
in
the
community.
But
we
do
still
discharge
about
six
percent
of
our
folks.
Most
of
them
have
come
from
a
personal
care
home
when
they
return,
and
then
you
see
jails
about
four
percent.
H
So
folks
who
have
active
charges
upon
discharge
might
go
back
to
jail
now,
many
of
those
many
times
that
might
be
dismissed
or
if
mental
health
court
is
an
option
and
that
might
be
they
might
be
able
to
be
diverted
from
jail
through
a
mental
health
court
and
some
go
on
to
other
settings.
And
if
you
had
any
questions,
we
could
talk
about
that
and
so
thinking
you
know
from
my
seat.
H
What
what
I
want
you
to
know
is
you
know:
hospitals
are
an
important
part
of
the
continuum
they're
but
they're
very,
very
expensive,
and
they
serve
a
very,
very
small
percentage
of
individuals
with
smi
an
important
one.
But
what
we
now
know
about
the
the
neurobiology
of
smi
and
the
conditions
that
cause
it
is.
H
We
can
change
the
trajectory
of
their
life
and
the
course
of
their
illness
to
prevent
the
level
of
disability
that
we
see
in
some
individuals
so
early
identification.
I
know
you
hear
that
all
the
time
prevention
is
the
best
medicine
early
intervention,
but
the
evidence
for
particularly
schizophrenia
is
very
clear.
H
That
programs-
and,
as
I
mentioned
one
of
the
problems
is
people
present
again,
while
they're
in
universities
or
while
they're
in
working
and
have
private
insurance,
and
our
private
insurance
providers
do
not
offer
some
of
these
services
like
assertive
community
treatment
and
do
not
offer
the
level
of
intent.
Families
sometimes
get
a
diagnosis
and
a
handshake
and
a
good
luck
and
those
are
the
calls
I
get.
What
do
I
do
now,
and
so
I
do
want
you
to
think
about
early
intervention.
Identifying
those
at
risk.
H
Intervening
early
and
enforcing
parity
is
very
important
in
that
regard,
and
then
you
know
we'll.
We
need
funding
to
create
a
a
recovery,
focused
system
of
care.
We
need
new
payment
models
to
make
our
cmhcs
viable.
Some
examples
of
those
include
the
ccbhc's
which
I
think
you've
heard
about
or
may
hear
about
from
our
colleagues.
That's
a
funding
model
that
will
help
us
provide
services
to
all
comers
and
not
just
on
an
individual
fee-for-service
basis.
H
So
we
can
do
some
of
the
kinds
of
things
that
keep
people
out
of
the
hospital
and
engage
them
so
that
their
adherence
is
better
and
diverting
people
from
the
justice
system
heard.
You
all
mentioned
that
mental
health
courts
are
a
very
important
part
of
this
and
then,
as
as
I
said,
preventing
the
decline
once
a
person
disenrolls
from
school
because
of
a
serious
mental
illness.
Their
likelihood
of
going
back
are
low,
so
we
need
to
keep
them
in
school.
H
We
need
to
get
them
employed,
they
need
purposeful
activity
and
purposeful
employment,
and
then
I
think
I'll
end
with
this
recommendation
for
looking
at
housing.
You
know
we
do
not
have
residential
mental
health
treatment
facilities
for
people
with
serious
and
persistent
mental
illness
in
kentucky,
and
the
thought
there
is
is
that
generally,
we
can
serve
them
outpatient
with
intensive
services,
but
they
have
to
have
a
place
to
lay
their
head
where
we
can
wrap
the
services
around
them.
So
that's
what
I
have
to
add
and
I'm
happy
to
take
any
questions.
A
Thank
you,
dr.
We
have
with
us
who
has
joined
us
representative,
moser
chairman
moser,
and
I
believe
she
has
a
question.
E
I've
I've
worked
a
long
time
to
to
to
see
some
of
the
this
conversation
happen,
and
so
I'm
very
happy
to
to
be
able
to
join
the
task
force
today
to
to
kind
of
hear
this,
I
have
a
question
about
the
assertive
or
the
act
team
who,
who
are
the
individuals
who
make
up
this
act
team?
What
exactly
are
they
tasked
with?
I,
I
think
I
I'm
very
intrigued
by
this
follow-up
model.
E
We
started
a
quick
response
team
in
northern
kentucky
dealing
with
addiction,
and
I
it's
my
understanding
that
they
now
serve
some
individuals
who
suffer
with
severe
mental
illness.
Is
this
who's
the
act
team
made
up
of,
and
I
have
a
follow-up
to
that?
I
think.
H
So
it's
it's
an
evidence-based
model
and
there
are
there's
large
act
teams
that
have
as
many
as
10
provider
members
and
then
there
are
smaller
ones,
but
typically
they
are
made
up
of
a
targeted
case
manager
off
a
peer
support
specialist,
often
in
a
a
person
who
is
called
a
community
support,
associate
who
might
spend
time
in
the
community
with
them
so
similar
to
a
community
health
worker,
but
a
community
support
associate.
H
They
would
have
a
physician
as
part
of
the
team
in
kentucky.
I
don't
think
the
physician
service
is
bundled
into
the
act
rate,
but
but
a
physician
is
is
separate,
but
a
key
member
of
the
team
and
even
for
folks,
not
on
medicine.
It's
important
that
they
meet
with
a
physician
on
a
regular
basis
to
talk
to
that
individual
about.
When
would
you
be
accept
medicine?
What
are
the
benefits
of
medication?
H
And
so
typically
it's
four
or
five
people,
and
then
the
other,
you
know
might
be
an
lcsw
another
therapist
that
would
meet
with
them
on
an
individual
basis.
So
a
therapist
case
manager,
peer
support,
specialist
physician
and
community
support
associates
are
kind
of
the
bare
minimum
for
an
enacting.
E
Okay,
and
if
I
may,
madam
chair
a
follow-up-
yes,
thank
you
so
the
the
act
team.
How
are
they,
how
are
they
activated
not
not
to
use
any
sort
of
bad
pun.
H
So
they
accept
referrals,
you
know
like
any
community
mental
health
center,
and
so
they
have
a
team
that
would
review
that
person's
referral
and
determine
whether
or
not
they
could
serve
them.
And
you
know
I
do
say
that
we
have
them
in
all
of
our
14
centers,
but
I
will
not
I'll
be
the
first
to
say
that
not
all
counties
and
all
of
our
14
community
mental
health
centers
have
access
to
act
teams,
so
it
might
depend
on
the
distance
from
where
the
act
team
is
located.
H
We
do
have
struggles,
you
know
if
folks
are
determined
to
be
potentially
violent
or
assaultive,
then
the
acting's
may
have
a
concern
about
serving
them
in
the
community,
and
so
some
states
have
forensic
act
teams
which
are
staffed
a
little
differently
where
they
can
handle
more
challenging
individuals.
H
So
right
now,
if
you're
on
an
act
team,
you
would
leave
the
act
team
if
you're
in
the
tim's
law
pilot
and
you
would
be
on
a
tim's
law
team
on
the
grant,
and
so
that's
what
we're
discovering
there.
What
does
that
team
need
to
consist
of?
How
often
does
the
contact
need
to
be
what's
required
to
make
the
reports
to
the
court
and
the
extra
work
required,
but
but
the
challenges
right
now
are
recruiting
staff
maintaining
them.
This
is
difficult
work.
H
These
are
individuals
often
hard
to
find,
and
sometimes
they
don't
open
the
door
and
sometimes
we
have
to
engage
them
in
creative
ways,
sometimes
they're,
you
know
homeless,
living
on
the
street
and
we
are
trying
to
serve
people
who,
who
might
be
living,
you
know,
marginally,
and
so
so
so,
staffing
and
recruiting
and
retention
and
the
reimbursement
rate
is
significant.
H
But
you
know
there
are
challenges
in
that
rate
covering
all
of
the
additional
non-direct
service
kinds
of
coordination
and
then
meeting
criteria
for
medical
necessity
and
things
like
that
are
often
some
extra
burden
for
for
administrative
folks.
But
but
it
is
a
key
key
model
for
for
keeping
these
folks
out
of
the
hospital
and
and
keeping
their
illness
managed.
A
E
Yeah
thank
you
for
that.
I
yeah.
If,
if
I
could
see
the
funding
model,
I
I
would
be
very
interested
in
just
you
know,
trying
to
to
see
how
how
that
really
breaks
down
on
a
state
level
and
if
I
don't
have
medicaid
is
involved,
but
I
don't
want
to
monopolize
the
time
here.
I
have
a
million
questions,
so
maybe
I
can
talk
to
you
offline
sure.
H
A
I
I
have
several
questions
doctor,
but
hopefully
they'll
be
short
answers
just
for
as
a
backdrop,
I've
been
running
mental
health
center
for
about
six
years,
but
my
background
is
really
in
business
in
terms
of
owning
and
running
some
businesses
so
forth.
So
that's
my
backdrop.
So
when
I
ask
these
questions
you
might
know
where
I'm
coming
from,
I
want
to
try
to
get
some
clarifications
on
your
slides,
particularly
number
four
and
five.
I
When
you
compare
the
number
when
you
look
at
the
number
of
the
the
budget
on
a
per
patient
basis,
mine,
what
I
can
tell
is
only
305
patients
for
100
116
million
dollars,
which
is
about
380
000
per
patient,
is
that
is
that?
How
is
that
a
correct
interpretation
of
this.
H
So
I'm
I'm
trying
to
get
back
to
that
slide
and
I'm
not
sure
so
you're
taking
the
total
of
the
116
million
and
dividing
by.
We
have
to
divide
by
the
total
number
of
individuals.
That's.
I
Right
and
that's
300
305,
based
on
slide
4
compared
to
slide
5.
H
I
I
That's
right,
but
but
but
you
have
an
abs
59
or
so
that
I
can
tell
for
central
state.
Is
that
throughout
the
year
or
is
that
no.
H
That's
that's
a
snapshot
of
that's
average
daily
census.
So,
on
tuesday
of
this
week
we
had
50.
okay,
but
we
served
200
people
this
week
and
so
we
for
the
whole
year.
If
you
look
at
slide
8,
that
shows
you,
the
number
of
people
served
annually
and
so
central
state
on
that
slide
is
looks
like
they
had
about
1200
or
so
people
they
served
that
year.
H
I
Not
go
down
when
the
facilities
get
smaller,
I'm
sure
you
got
a
lot
of
fixed
costs,
and
I
understand
that
and
I
want
to
go
back
what
you
said
a
second
ago
in
terms
of
emissions
and
and
readmissions.
If
I,
if
I'm
looking
at
page
eight,
your
admissions
for
2021
is
1700
and
your
readmissions
on
slides
12
is
13.
So
that's
a
pretty.
If
of
those
is
that
a
subset
of
the
1200
to
the
1700,
so
you're
emitting
a
whole
lot
more
than
you're
taking
in
for
new
new
folks.
H
I
Trying
to
get
down
to
treatment
and
the
care
that
you're
providing
which
I'm
not
doubting,
but
I'm
just
trying
to
get
a
better
understanding.
So
if
you're
taking
it
doesn't
matter,
if
the
average
is
whatever
then
you're
taking
in
the
averages
x
and
then
your
re-emission
is
y,
but
your
y
is
very
close
to
x,
then
I'm
trying
to
figure
out
what's
going
on
in
terms
of
you
said
that
there's
a
lot
of
readmissions
from
folks
so
that
they
don't
because
one
reason
is
called
your
housing.
H
I
do,
but
I
and
I
apologize
and
we'll
try
to
get
you
some
clarity
on
the
numbers,
but
the
the
number
for
readmissions.
If
you
look
at
slide
12,
that's
in
on
the
on
the
left
axis,
that's
the
percent
of
the
individuals
admitted
total
that
return,
so
it's
10,
so
we
have
about
a
10
readmission
rate
within
across
all
of
our
hospitals
and
that's
not
that's
not
unlike
any
of
the
national
averages.
Some
of
our
hospitals
are
lower
than
the
national
average.
H
Some
are
slightly
higher,
but
but
we
readmit
about
10
of
all
of
the
folks
we
discharge
within
30
days
and
then
within
90
days.
We
readmit.
If
you
look
at
the
that
number,
is
986.
That's
about
what
close
to
20
percent
get
readmitted
and
it's
what's
interesting
is
I've
looked
we
look
a
lot
so
who's
getting
readmitted
because
I
used
to
think
well
the
reason
we
readmit
people
is
because
we
don't
keep
them
long
enough
right.
So
if
we
discharge
someone
too
fast,
they
return.
H
H
We
don't
have
perhaps
the
right
level
of
support
for
them
in
the
community
to
keep
them
from
coming
back,
because
often
they
leave
they're
stabilized,
but
they
don't
stay
stabilized
once
they
return
to
the
community
and
that's
why
tim's
law
was
an
important
tool
that
can
help
us,
but
it's
still
very
difficult
to
to
force
people
to
take
medications
who
do
not
want
it.
We,
we
are
not
able
to
break
into
someone's
house
with
a
white
jacket
on
and
then
syringe
and
give
them
an
injection
against
their
will.
H
H
We
can
use
a
lot
of
tools,
but
but
but
again
our
our
10
readmission
rate
within
30
days
is
not
good,
not
proud
of
it,
but
but
unfortunately,
kind
of
around
the
national
average.
I
Okay,
slad
15:
do
you
get
compensated
for
transportation?
I
Now?
How
do
you
or
do
you
yeah?
Do
you
get
compensated
for
transporting
the
patient
after
discharge.
I
Okay,
okay
and
then
one
last
question
the
parody.
Could
you
give
me
a
like
a
like
a
30
seconds
observation
on
parity
when
it
comes
to
mental
health
versus
the
the
physical
size
of
of
health?
H
I
mean,
I
think,
kentucky
again
was
progressive
and
early
in
adopting
parity
requirements.
I
think
the
challenge
has
been
enforcing
them
and
I
sit
on
the
eating
disorder
council
and
today
that
was
the
discussion
there
is,
they
don't
believe,
there's
parity
for
eating
disorder
services.
They
believe
that
medical
necessity
criteria
are
too
rigidly
interpreted.
If
you
have
cancer,
you
get
lots
of
follow-up
and
you
get
a
nutritionist
and
you
get
a
you
know
mental
health
services
for
your.
H
H
So
I
really
think
the
issue-
and
I
know
this
is
being
addressed
on
a
federal
level-
is
enforcement
and
we
we
work
with
the
department
of
insurance,
and
I
know
they
do
actively
investigate,
but
but
we
just
have
to
understand
that
we
we
need
to
fund
mental
illness
as
an
illness
and,
like
other
chronic
illnesses
like
diabetes
and
cancer,
and
offer
the
whole
array
of
services.
B
Thank
you,
madam
chair
and
and
dr
brenzel
good,
to
see
you,
I
guess
in
your
presentation,
just
to
clarify
based
on
the
recent
questions.
I
think,
there's
on
that
average
you
get
about
6,
800
or
so
admissions
per
year
at
all
four
hospitals
combined,
and
so,
if
you
compare
that
to
the
slide
told
it
makes
it
makes
more
sense
when
you
compare
the
percentages
from
that
on
mental
health
parity.
B
Also,
if
you
have
anybody,
we
passed
that
law
and
if
people
are,
if
you
know,
there's
been
some
fines
levied
against
some
of
our
insurance
companies
that
haven't
followed
that
if
you
have
people
that
aren't
doing
that,
please
notify
us
executive
branch.
We
need
to
hold
our
insurance
companies
accountable.
The
one
thing
I
I
wanted
to
just
maybe
you
can
comment
on.
I'm
involved
a
lot
in
long-term
care.
B
Obviously,
and
I
do
a
lot
of
nursing
home
work
when
I
see
the
amount
of
discharges
point
five
percent
boy,
I
can
tell
you
it
doesn't
feel
like
that
in
long-term
care.
I
can
honestly
say,
if
only
I
mean
I
know,
this
is
only
from
state
operated
facilities
and
there's
people
that
go
to
private
hospitals
as
well.
B
I
would
easily
have
you
know
double
that,
just
in
my
small
senses
of
patients
that
I
see
every
month,
I'd
say
at
least
15
to
20
percent
of
what
I
have
right
now
in
nursing
for
people
with
schizophrenia
and
a
lot
of
not
just
dementia
related
but
true
schizophrenia
and
severe
mental
illness.
That
I
manage
and
I
I'm
not
a
psychiatrist,
I'm
not
an
expert.
I
do
the
best
that
I
can.
B
B
If
there's
been
any
consideration
from
our
state
hospitals
to
provide
that
for
private
nursing
homes,
because
we
have
psych
teams
that
come
in,
they
don't
come
in
very
often,
even
if
something
can
be
done
through
telehealth,
because
the
people
that
we
have
coming
in
are
not
physicians.
A
lot
of
the
times
provide
that
care
and
are
probably,
I
probably
have
more
expertise
in
some
of
them
who
offer
recommendations
and
don't
really
help
our
patients.
And
so
I
get
a
sense
of
there's
a
churn
from
some
of
those
folks,
rather
than
actually
providing
them
care.
H
So
you
know,
I
think
I
think
you
mentioned
the
issue
of
the
lack
of
some
people
have
said
it's
psychiatrist.
Right
now
is
like
a
unicorn
they're
awfully
hard
to
find,
and
so
I
think
we
have
a
serious
workforce
issue,
and
that
makes
it
a
challenge.
As
you
mentioned,
65
of
all
psychotropics
are
prescribed
by
primary
care
physicians,
so
training
for
them
is
very
important.
I
hope
you'll
consider
utilizing
expertise
at
the
university
of
kentucky
and
university
of
louisville.
H
I
graduated
from
you
did
medpedes
I
did
pete's
psych,
so
I
did
primary
care,
but
also
decided
to
specialize
in
behavioral
health
uk
is
now
starting
a
med,
psych
residency,
not
sure,
if
you're
aware
of
that,
but
we
have
to
train
a
workforce
and
we
have
to
offer
those
in
primary
care
access
to
training
because
they
are
going
to
be
pressed
into
managing
just
just
like
you
are.
It
sounds
like
for
the
folks
you
care
for
in
long-term
care.
H
I
mean
I'd
love
to
say
that
we
had
enough
staff
to
be
able
to
sort
of
open
and
provide
expertise.
You
know
for
our
folks
with
intellectual
disabilities,
we
have
created
icf
clinics
where
we
take
our
expertise
from
our
our
staff
facility,
our
facility
staff
who
work
in
our
facility
and
then
offer
it
to
folks
after
they
leave.
H
The
challenge
with
that
model
is
that
we
are
right
now
understaffed
in
our
hospitals,
we're
having
to
use
locum,
tenants
positions,
we're
constantly
recruiting
and
losing,
and
so
it
would
require
more
stability
in
our
staff.
But
it's
certainly
a
thought
and
then
uk
is
engaged
in
some
really
innovative
models
which
we
think
might
help
is
they're
going
to
partner
with
community
mental
health
center.
There,
new
vista
or
maybe
they'll
provide
the
act.
H
But
I
think
you're,
absolutely
right.
We've
got
to
grow
workforce,
you
know
we,
we
didn't
have
the
sustainable
funding
to
continue
to
operate
those
those
pers
that
personal
care
home.
We
were
concerned
about
covid
in
needing
it.
If
we
had
to
move
anyone
from
another
facility,
we
wanted
to
have
some
space
available,
so
we're
looking
at
sort
of
repurposing
one
of
those
as
a
as
an
mtaf
crisis
center
and
also
uk,
is
looking
at
doing
some
outpatient
collaboration
with
new
vista's
pack
team
and
doing
integrated
care.
H
H
Sometimes
they
get
the
primary
care
and
so
yeah
you're
the
ones
pressed
into
renewing
their
meds.
But
but
I
I
think
that's
that's.
The
issue
for
for
us
is
growing
and
utilizing
our
psychiatry
staff
in
the
most
effective
way
like
using
telehealth
like
having
them
collaborate
as
a
member
of
the
team
and
provide,
but
we
could
certainly
look
at
how
do
we
extend
the
expertise
within
our
hospitals
to
the
community
to
the
community
as
we
get
through
our
own
staffing
crisis?.
D
Thank
you,
madam
chair,
and
thank
you,
dr
brinsle,
on
slide.
Seven,
you
I
felt
like
you
were
implying,
maybe
a
changing,
because
you
said
in
current
statute:
they
have
to
be
released
if
they
don't
meet
the
criteria.
I
just
wonder
what
are
you:
were
you
implying
some
sort
of
change
in
statute
and
what
would
that
be?.
H
No,
I
I
just
wanted
you
to
be
aware.
You
know
that
we
don't
have
the
legal
ability
because
to
keep
people
beyond
when
they
meet
this
criteria,
and
this
is
not
new
criteria.
This
is
kentucky's
criteria,
it's
similar
to
other
other
states,
and
it's
it's.
It's
about
civil
liberties
right
and
the
whole
societal
question
is:
do
you
have
a
right
to
not
take
your
medicine
for
your
high
blood
pressure
or
right
to
not
take
your
medicine
to
a
right
to
drink
alcohol?
To
the
point
where
your
your
liver
is
failing?
H
And
so
the
question
is:
do
you
have
a
right
to
to
have
untreated
mental
illness?
I
you
know
we
do
step
in
as
society.
We
do
use
our
laws
to
try
to
care
for
folks
who
who
aren't
able
to
care
for
themselves,
but
our
statutes
sort
of
clearly
specify
you
know
how
long
we
can
keep
people
and
there
are
interpretation
issues,
because
you
notice
this
doesn't
say
imminent
danger
to
sell
for
others,
and
the
question
is
what's
danger
and
how
is
danger,
meaning
that
I'll
freeze?
H
So
you
know
we
get
more
admissions
when
the
temperature
is
minus
20,
because
if
you're
not
able
to
come
in
out
of
the
cold
you're
a
danger
to
yourself
well,
you
might
not
that
same
criterion
might
not
be
met
other
times
of
the
year.
Unfortunately,
and
so
there's
there's
a,
but
we
have
court
in
every
one
of
our
facilities.
Judges
are
the
ones
making
these
decisions.
H
A
A
E
A
E
Chair
this
is
veronica
cecil,
with
kentucky
medicaid.
J
J
We
go
okay,
so
actually
in
2020
we
started
a
really
intense,
deep
dive
related
to
research
on
smi
and
ncd
waivers
and
the
different
authorities
that
we
might
be
able
to
take
a
look
at
for
kentucky
for
kentucky
ourselves.
So
we
looked
at
1915,
c's,
1915
eyes
and
also
1115
waivers.
J
We
also
looked
at
what
other
states
were
doing
related
to
these
particular
waivers
that
I
have
listed
on
the
screen
we
in
this
year
on
9-1
we
hired
a
dedicated
staff,
so
we
have
a
dedicated
staff
now
for
the
smi
sed
initiatives,
we've
completed
lots
of
training
and
collaboration
and
I'll
talk
a
little
bit
more
about
the
collaboration
later
on
a
federal
level
related
to
smi
and
sed,
and
what
options
we
have
for
here
in
kentucky.
J
We
have
had
ongoing
conversations
with
with
cms
the
center
for
medicare
and
medicaid
services.
I'm
currently
right
now-
and
I
just
spoke
to
them
this
morning.
Cms
is
currently
recommending
that
we
would
add
an
smi
sed
waiver
under
the
same
authority
as
our
approved
sud
1115
waiver,
that
we
have-
and
we
also
some
other
things
that
we
did.
It
was
last
year
at
the
end
of
last
year,
robert
wood
johnson
foundation,
as
well
as
the
state
health
and
values
strategies
group,
which
we
call
shivs
reached
out
to
us
for
technical
assistance.
J
We
did
apply
for
the
technical
assistance
and
we
were
approved,
it's
a
six-week,
technical
assistance
that
they
can
offer
to
us
for
free,
and
we
ask
at
that
time
to
hold
off
until
we
could
course
get
our
staff
up
and
going,
which
was
just
september
this
month
of
this
year.
So
we
have
our
next
kickoff
with
shivs
on
october,
the
20th
next
month.
J
So
although
we
don't
have
an
smi
sed
waiver
right
now,
we've
had
many
initiatives
that
we're
with
that.
We
are
working
on
or
getting
started
in
the
next
couple
of
months
or
year,
and
they
all
include
smi
sed.
So
I
thought
I
would
just
share
a
couple
of
those
with
you,
and
this
may
be
more
than
that.
You
want
to
hear
today.
So
if
you
have
any
questions
later,
you
can
just
reach
back
out
to
me
and
I
can
help
with
those.
J
As
you
heard,
dr
grenzel
speak,
we
have
one
initiative
that
we're
working
on
that
will
roll
out
january
of
2022
is
the
certified
community
behavioral
health
clinic
and
that's
what
we
call
the
ccbhc.
J
This
is
a
clinic
that
will
be
certified
and
it
will
provide
a
comprehensive
array
of
services
that
would
include
mental
health,
substance
use
disorder
and
physical
health
services,
and,
as
you
heard,
dr
brinsle
also
speak
that
we
need
that
integrated
care
piece.
So
this
is
a
really
good
opportunity
for
the
state
of
kentucky
to
really
pull
together
and
have
that
integrated
care
for
individuals
and
the
members
out
in
the
community.
J
So
this
would
be
available
to
any
individual
in
need,
and
it's
not
just
limited
to
smi
or
sed.
As
you
can
see,
it's
for
long
chronic
addiction,
mild
or
moderate
mental
illness
substance
use
disorders
and
complex
health
profiles,
so
we're
hoping
to
catch
some
of
those
folks
that
have
the
dual
diagnosis
and
have
some
chronic
health
conditions
as
well.
J
J
So
other
initiatives
that
initiatives
that
we
have
going
on
is
our
cms
housing
collaborative
and
we've
been
participating
over
nine
months
in
a
housing
collaborative
on
a
federal
level
which
started
out
as
a
housing
initiative
related
to
substance
use
disorder,
but
kentucky
soon
saw
that
we
needed
to
talk
more
about
not
just
about
sud,
but
we
needed
to
talk
about
smi
and
sed.
We've
also
talked
about
just
the
homeless
population
in
general,
so
this
is
a
really
great
good
group,
collaborative
that
we
have
here
in
kentucky.
J
Really
we
have
kentucky
housing
authority
is
on
department
of
behavioral.
Health
is
also
part
of
that
group.
Opioid
crisis
response
groups
are
on
so
we're
taking
a
look
across
the
board
and
that's
still
ongoing.
We
meet
we're
meeting
on
a
regular
basis.
Our
collaborative
is
over,
but
the
state
of
kentucky
chfs
decided
to
continue
to
meet,
because
we
do
know
that
there
is
a
great
need
for
housing
assistance
here
in
kentucky.
J
Recently,
we
applied
for
this
grant
through
the
american
rescue
act
plan,
which
you
may
hear
the
word
arpa
come
up,
and
lo
and
behold
we're
so
excited
just
this.
Last
saturday
morning
I
received
an
email
that
we
one
we
got
where
we
were
awarded.
The
planning
grant
so
very
excited
about
that,
and
this
was
a
really
good
collaboration
between
dms
and
dbh,
to
kind
of
pull
all
of
our
different
funding
streams
and
our
different
programs
together
to
kind
of
enhance
or
expand
the
crisis
services,
and
we
would
like
to
see
a
vis.
J
Our
vision
is
to
see
this
comprehensive,
behavioral
health
crisis
model
for
kentucky
so
very
excited,
and
I
can
tell
you
all
more
about
that
later.
I
just
wanted
to
share
that
with
you.
J
Another
thing
that
I
wanted
to
mention
is,
as
you
may
be
aware,
in
our
hcbs
enhanced
fmap
request
recently
that
the
department
of
medicaid
sent
in
to
cms,
we
also
embedded
crisis
dollars
that
could
be
used
across
across
the
board,
which
would
include
smi
and
sed,
and
we
also
asked
for
a
feasibility
study
to
be
able
to
to
for
smi
sed
and
also
to
take
a
look
at
the
housing
and
employment
supports.
So
those
are
embedded
in
the
hcbs
enhanced
fmap
that
you
may
hear
in
other
meetings.
So
we
had
that
embedded.
J
We
did
check
with
cms
today
we're
hoping
to
have
an
answer
back
on
those
requests.
Maybe
next
week.
J
That's
pretty
much
it.
I
wanted
everyone
to
know
that,
although
we
don't
have
that
waiver
in
kentucky
right
now,
we
are
working
diligently
on
other
programs
that
include
the
smi
sed
populations,
and
you
will
hear
us
say:
smi
sed
we're,
not
just
limiting
it
to
just
smi
we're,
including
both
of
those
populations
to
include
include
the
children's
programs
as
well.
So
do
you
have.
B
You,
madam
chair,
and,
of
course,
these
grants
are
of
interest.
I
mean
we're
working
on
several
I'm
working
on
several
task
forces
this
summer.
One
of
them
is
an
sjr59
looking
at
substance,
use
disorder
and
people
for
housing,
which
is
another
obviously
important.
A
lot
of
those
folks
have
comorbid
conditions
of
mental
illness
and
we're
being
alerted
of
different
small
pots
of
money
here
and
there
that
could
help
for
that.
We're.
Looking
at
developing
pilot
projects
for
sud
population
do
we
know
how
big
these
grants
are.
How
much
money
are
we
talking
about?
B
J
So
the
ccbhc
is
actually
a
demonstration
that
will
allow
kentucky
to.
There
was
a
2016
application
that
included
four
of
our
cmhcs,
and
so
this
one
will
be
a
little
bit
different.
It
will
be
to
provide
those
services
within
a
very
intensive
array
more
so
than
normal.
J
It
just
happens
to
be
the
four
cmhc
they're
providing
those
services,
but
they
will
be
certified
to
provide
a
higher
array
of
services
if
that
makes
sense
and
more
of
that
integrated
care,
so
the
cmhcs
that
will
be
ccbhcs
going
forward
will
be
able
to
receive
payment
for
those
enhanced
services.
Does
that
make
sense?
Does
that
help.
B
J
Our
our
estimated
award
is
about
800
000.
The
maximum
allowed
award
was
1
million
up
to
20
states,
so
I
think
we're
right
at
800
000
for
the
planning
grant.
A
Representative
wilner
your
question
for
our
presenter
right
now
and
then
I
think
you
also
have
a
question
for
dr
brinsle.
If
he's
still
on,
I.
E
J
So
it's
really
about
the
population,
it
would
be
the
adult
population
over
18
versus
the
younger
children
that
are
under
18..
It's
just
the
populations,
but
really
one
of
the
things
that
we've
been
trying
to
focus
on
for
the
11
15,
of
course,
like
dr
brindle
said,
is
residential
is
a
big
issue.
Employment's
a
big
issue:
the
integrated
care
is
a
big
deal.
I
was
trying
to
think
of
some
other
things
and
the
care
coordination
in
general.
J
E
It
does
so
I
mean
is
the
distinction
between
smi
and
std
the
age
if
it's
under
18,
it's
sed,
if
it's
over
18,
it's
sm
just
because
we
don't
diagnose
people
with
smi's
until
they're,
18
or
older,
so
it's
a
definitional,
yeah.
Okay,
all
right!
Thank
you.
Thank
you
and
I
think
madam
chair
was
going
to.
Let
me
go
back
in
time
and
asked
dr
brenzel
a
quick
question.
Yeah
and
I
thank
you.
Thank
you
very
much,
madam
chair,
dr
brensel.
Thank
you.
E
So
much
for
your
presentation
and
the
slide
with
the
recommendations
was
so
helpful,
so
concise
and
just
you
know
that
I
I
hope
that
we'll
all
take
that
to
heart.
When
we
get
to
the
final
stage
of
of
our
work
as
a
task
group,
you
mentioned
specifically
the
revolving
door.
Again,
you
know
reducing
that
issue
and-
and
representative
fleming
was
also
asking
about
that
and
improving
outpatient
follow-up,
and
so
I
I
really
want
to
tie
that
back
into
the
tim's
law
question
and
commissioner
morris's
first
presentation.
E
We
know
we're
going
to
have
jefferson
county
covered,
we're
going
to
have
western
kentucky
covered
eventually.
Are
there
any
areas
of
the
state
that
the
current
grant
that
the
current
funding
would
leave
out
for
the
tim's
law
implementation.
H
I'm
not
going
to
defer
to
commissioner
morrison
and
she's
been
more
directly
involved.
I
mean,
I
think,
what
you
heard
her
say
is
that
part
of
this
is
very
deliberate
and,
and
we
intend
to
try
to
understand
what
it
takes
to
do
this
and
what
it
take,
what
what
are
the
upfront
costs
and
then
how
long
before
you
realize
a
return
on
investment
and
can
we
rebalance
dollars?
I
mean
if
we're.
If
we're
going
to
have
savings,
we
got
to
figure
out
where
how
to
move
it
but
I'll
I'll.
Let
commissioner
morris
talk
about
that.
C
Yeah,
thank
you
for
the
question,
so
on
slide,
three
there's
a
map
that
shows
where
we
are
definitely
going
to
be,
which
is
the
purple
and
the
green
where
we
hope
to
be,
which
is
the
yellow.
The
rest
of
the
map,
which
is
a
light
blue,
will
not
get
any
services
under
this
grant.
The
grant
it
just
the
money
is
not
going
to
stretch
that
far
so
we
right
now,
I
would
say
we
feel
pretty
optimistic.
We're
going
to
be
able
to
stretch
it
to
serve
those
yellow
counties.
C
The
purple
is
all
inclusive
of
the
central
state
region.
They
don't
there's
just
two
cmhcs
that
admit
to
that
hospital
for
western
state,
all
four,
the
green
and
the
yellow
all
admit
to
the
western
state
hospital.
So
definitely
the
green,
hopefully,
the
yellow,
and
just
just
for
your
knowledge
that
each
of
our
four
state
designated
hospitals
take
admissions
from
specific
counties.
So
if
your
county
is
assigned
to
eastern
state
hospital,
it
won't
be
touched
by
this
particular
grant.
Does
that
answer
your
question.
E
A
Thank
you
very
much.
We're
gonna
go
ahead
with
the
rest
of
the
agenda
and
we're
going
to
have
to
move
a
little
more
swift.
At
this
point
we
have
three
additional
speakers
and
I
believe
only
one
is
here
in
person,
andrea
blake.
Would
you
come
forward?
I
think,
due
to
time
constraints
also
that
we're
going
to
have
all
three
or
four
or
five
of
you
present
to
the
task
force,
and
we
will
take
questions
at
the
end
of
this
presentation.
A
F
Hear
them
so
sorry,
thank
you
so
yeah,
my
name
is
andrea
blake
and
I'm
just
here
as
a
family.
Member
of
a
dual
diagnosis
of
the
severe
mental
illness
and
substance
abuse.
A
F
F
But
I've
I've
taken
the
opportunity
to
read
the
previous
minutes
and
I'm
so
encouraged
to
just
see
that
the
issues
that
my
family
has
personally
faced
is
being
hit
head-on
by
this
committee.
It
brings
me
great
relief,
the
things
that
we've
have
have
to
endure,
it's
not
that
it's
been
impossible,
but
it's
because
my
sister-in-laws
who
we're
caring
for
we
are
guardians
of
her
now.
F
F
So
I
say
that
just
by
saying
that
a
lot
of
the
programs
that
I
have
seen
be
put
into
place
are
beautiful
in
theory,
but
the
reality
of
it
when
it
comes
to
everyday
life,
hasn't
worked
so
smooth
for
us
personally,
and
so
that's
just
the
small
part
that
I
want
to
share,
and
so
my
sister-in-law
has
been
admitted
into
western
state
hospital
14
times
baptist
health
hospital
health
unit
five
times
and
lincoln
trail
behavioral
health
hospital
once
in
only
six
years.
So
we
are
one
of
the
revolving
door
cases.
F
She
has
shown
some
intellectual
disability
through
her
schooling
through
high
school,
and
so
there's
there's
really
a
fine
line
from
us
on
what
is
her
mental
disability,
intellectual
disability,
one
is
she's
diagnosed,
schizophrenics
gets
so
effective
and
bipolar.
So
what
is
that?
And
then
also
what
is
from
the
substance
abuse
so
now
that
substance
abuse
isn't
in
the
picture,
we're
able
to
at
least
narrow
it
down
to
those
two,
but
there's
still
a
lot
that
we
don't
know
go
into
what
category
with
that
for
many
years.
F
She
would
call
us
asking
for
help
and
we
would
tell
her
we
were
willing
to
help
her,
but
not
enable
her
so
help
me
full
rehabilitation,
putting
commitment
into
getting
better
and
things
like
that,
and
that's
not
the
type
of
care
that
she
wanted,
and
so
because
of
our
answer
and
her
life
choices.
We
really
grew
apart
and
throughout
the
years
after
that,
we
really
saw
her
decline
and
especially
in
the
past
two
years,
that
it's
been
very
difficult
for
her.
F
So
in
january
my
husband-
and
I
were
talking
about
this
and
we
decided
that
we
probably
need
to
figure
out
what
was
going
on
because,
like
I
said
there
was
a
big
distance
in
our
lives,
and
so
we
really
didn't
have
an
idea.
What
was
going
on,
we
just
knew
she'd
get
arrested,
she'd
go
to
western
state
and
she'd
be
right
back
out
in
either
72
or
20
72
hours
or
21
days,
so
we're
very
thankful
for
chief
harvey
and
the
greenville
police
department
and
all
that
they
did.
F
He
took
the
time
to
sit
down
with
us.
He
explained
to
us
the
mental
health
care
process.
Again
we
had
no
knowledge
of
it.
We
thought
she
was
getting
the
care
that
she
needed,
but
after
sitting
down
with
him-
and
this
is
probably
not
the
correct
terminology-
but
we
have
phrased
it
this
way.
So
what
she
was
getting
was
what
we
call
phase
one
she
would
go
to
western
state.
She
would
stay
there
until
she
was
no
longer
suicidal
or
homicidal
and
then
she
would
be
released,
and
that
is
not
an
appropriate
treatment.
F
So
her
14-day
program
turned
into
a
four-month
program,
and
so
we
were
very
grateful
for
that.
But
in
when
we
spoke
with
chief
harvey,
it
was
also
at
that
time
he
recommended
a
guardianship
over
her,
and
so
that's
how
we
were
even
able
to
get
her
into
lincoln
trail
behavioral
hospital
it
had.
We
didn't
understand
guardianship.
F
You
know,
I
mean
she's
schizophrenic
and
on
a
drug
abuse.
So
you
know
if,
if
us
as
a
family,
take
guardianship
of
her
and
she
murders,
someone
are
we
responsible,
and
so
we
had
to
do
some
digging
in
on
things
like
that,
to
really
figure
out
the
process
as
well
and
but
as
we
went
through
all
of
that
again,
the
muhlenberg
county,
we
cannot
sing
their
praises
enough
once
he
sat
down
and
talked
to
us.
We
went
and
got
the
paperwork.
F
We
filled
out
the
paperwork
that
night
we
returned
it
the
next
morning
and
by
that
afternoon
we
had
emergency
guardianship,
so
we
were
able
to
move
quickly
because
they
understood
what
she
needed
and
they
were
willing
to
make
those
steps
for
her,
and
so
we
always
want
to
give
them
the
praise
that
they
deserve,
because
without
them
our
family
wouldn't
be
in
the
position
that
we're
in
at
this
point
either,
and
so
once
we,
where
our
problems
really
start,
is
what
she
so
well.
F
Okay,
so
we
get
the
guardianship
and
then
before
we
could
find
her.
She
gets
arrested
again,
and
so
that
delayed
us
getting
her
into
the
lincoln
trails
for
a
little
bit.
But
it
did
give
us
an
opportunity,
then,
to
speak
to
her
court
appointed
attorney
and
so
again
because
they
understood
that
the
I
mean
obviously
she's
a
criminal.
F
I'm
calling
lincoln
trails
making
sure
they
have
a
bed
available,
and
I
have
called
them
probably
ten
times
in
this
two
week
period,
making
sure
everything
was
lined
up,
and
so
at
this
point
it's
the
very
first
time
they
mention
oh
well.
She
can't
has
to
wait
24
hours
after
getting
out
of
jail
before
the
insurance
will
pay,
and
so
I'm
in
a
panic,
because
you
know
what
do
we
do
with
her
for
24
hours,
and
so
I
have
a
seven-year-old
daughter.
F
So
her
coming
home
with
us
was
not
an
option
at
that
time,
and
so
we
thought
we'll
call
the
local
pennyworld
center
and
see
what
help
we
can
get
there.
Maybe
they'll
do
an
evaluation
and
put
her
in
western
state
for
the
24
hours.
Let
us
pick
her
up
there.
We
called
penny
royal,
they
told
us
she
did
not
have
insurance
and
they
would
not
even
see
her
and
so
we're
in
the
parking
lot
trying
to
figure
out
what
to
do.
F
And
thankfully,
at
that
point
vicki
harvey
and
his
employee
at
the
detention
center,
she
realized
what
was
going
on
and
it
all
had
to
do
with
the
insurance.
And
again
this
is
not
my
specialty,
but
I
guess
once
an
inmate
gets
incarcerated.
F
Their
insurance
gets
canceled
for
the
time
period
that
they're
in
and
then
it
gets
reinstated
once
they
get
out,
but
because
the
jail
and
detention
center
and
were
familiar
with
this
case,
they
learned
that
she
did
not
need
her
insurance
cancelled
ever
and
so
once
we
realized
that
was
a
problem.
We
were
able
to
take
her
to
lincoln
trails
right
away,
but
I
have
just
I
have
been
told
that
you
don't
get
turned
down
for
mental
health
because
of
insurance
is
why?
F
Because
of
no
insurance
is
why
I
wanted
to
mention
that,
because
in
reality
it
did
happen
after
she
was
in
lincoln
trails
again,
she
was
there
for
a
four-month
period
and
we
were
told
whenever
we
got
her
admitted
in
that
she
would
be
assigned
an
act
team
in
that
when
it
came
close
to
discharge,
we
would
be
contacted
three
days
prior
by
this
act
team
and
that
we
would
meet
with
them
about
what
our
next
steps
would
be.
F
While
she
was
there,
it
was
during
the
coveted
restrictions
of
this
year,
so
we
weren't
able
to
visit
her.
So
we
really
had
no
idea,
I
mean
I
would
we
could
call
as
much
as
we
wanted
and
I
called
several
times
a
week.
She
would
either
pick
up
the
phone
and
hang
up
on
me
or
she
would
ask
me
for
cigarettes.
So
if
it
was
a
need,
she
would
talk.
F
Otherwise
I
wasn't
even
getting
to
talk
to
her,
and
so
it
came
time
and
they
towards
the
end
of
it,
and
they
told
me
that
they
were
having
a
hard
time
finding
her
a
place
to
go
and
asked
if
I
could
join
them
and
trying
to
locate
that,
and
so
I
welcomed
that
with
them,
and
you
know
just
kind
of
talk
to
them
about
what
like
what
are
we
even
looking
for?
F
I
don't
even
know
where
I'm
calling
but
yeah
I'll
come
on
board,
and
so
they
mentioned
in
the
personal
care
home
they
had
tried
to
get
her
submitted
in
well,
I
have
to
backtrack
a
little
bit
sorry,
so
she
ran
out
of
insurance
day.
F
She
had
medicare
a
and
b
and
she
ran
out
of
the
maximum
days
of
that,
and
so
we
had
to
apply
for
medicaid,
but
instead
of
getting
a
full
medicaid,
she
got
a
q
b
service
which
cut
off
some
of
the
treatment
plants,
and
so
they
were
hoping
to
do
a
shock
treatment
plan
with
her.
But
we're
not
allowed
to
do
that,
but
I
don't
know
if
it's
because
of
insurance
or
whatever
reason
of
that
and
so
and
then
that's
when
they
started.
F
Looking
for
a
place
to
live
and,
like
I
said
in
the
beginning,
they
had
told
us
that
we
would
have
a
three-day
period
to
meet
with
them
and
talk
about
the
thing.
But
I
ended
up
getting
a
phone
call
saying
that
she's
getting
out
the
next
day
and
I'm
like
well
wait.
You
know
like
this,
isn't
following
your
protocol
for
one
I've
not
been
contacted
by
the
act
team.
I
have
no
idea
how
she
is
mentally.
What
are
you
telling
me?
F
F
She
seemed
even
possessed
at
that
point
and
so
and
not
knowing
if
she
still
was
or
not
was
scary
again
to
bring
her
home
with
our
daughter
being
there,
but
even
at
that
point
I've
still
never
heard
from
the
act
team.
I
never
unders.
I
did
talk
to
the
discharge
nur
or
the
discharge
doctor.
All
I
got
told
at
that
point
is
that
she's
stable.
I
asked
what
does
that
mean
and
they're
like
well
she's
as
good
as
we
can
get
her
and
I'm
like.
F
I
still
don't
know
what
that
means,
and
so
we
were
thankful
for
the
facility
to
be
able
to
take
her
in
and
we
picked
her
up
and
drove
her
there
that
same
night,
and
it
was
also
during
this
time
of
speaking
with
the
discharge
nurse
that
we
were
told.
F
Maybe
we
shouldn't
do
the
guardianship
of
her
and
that
we
should
let
the
state
have
guardianship
over,
because
if
the
state
had
guardianship
over
her,
some
place
would
have
to
take
her
and,
and
so
it
wouldn't
be
such
a
trial
between
us
for
that
to
happen,
and
then,
when
I
finally
ended
up
telling
her
well
another
option
she
gave
us
was
just
to
let
her
be
homeless
and
that
did
not
set
well
with
me,
and
I
just
told
her
right
away.
F
You
know
she
said
it
happens
all
the
time
and
I
just
explain
you
know,
I'm
sorry
that
it
happens
all
the
time
it
breaks
my
heart
that
it
does.
But
if
it's
somebody
that's
in
my
family,
it
won't
at
all
cost,
and
so
it
was
then
that
she
realized.
You
know
we're
really
serious
about
making
sure
she's
in
the
right
care
and
stuff,
and
so
at
this
time
like
we
really
had
to
start
praying
about
what
was
best
for
her.
F
You
know,
because
we're
very
ignorant
to
all
of
this,
like
we
have
zero
knowledge
at
all,
and
I
mean,
thankfully,
things
are
falling
into
place
as
we
need
them
to
be,
but
we
are
just
not
educated
in
it,
and
so
at
this
the
time
that
we
were
praying
do
we
need
to
stay
guardian
like.
Is
that
really
what's
best
for
her
or
do
we
need
to
give
that?
I'm
very
thankful
and
he's
joining
here
with
me
today,
jonathan
rouse,
from
the
kentucky
guardian
association
reached
out
to
me.
F
I
had
joined
that
trying
to
learn
about
schizophrenia,
trying
to
learn
about
what
guardianship
would
look
like
for
us
and-
and
I
had
sent
an
email
in
and
he
reached
out
and
called
me
and
just
explained
the
whole
process
of
it
all,
and
so,
just
by
being
educated
by
that
showed
me
like.
We
need
to
fight
for
her
the
best
that
we
can
and
so
from
him
sharing
his
knowledge
with
me.
I
was
able
to
move
forward
and
then
we
decided
to
continue
in
as
her
care
when
she
entered
into
the
personal
care
home.
F
They
provide
three
meals,
a
day,
medicine
management,
and
then
they
have
outsources
that
come
in
there's
a
organization
called
hope
and
healing
in
madisonville
kentucky
they
meet.
They
pick
up
patients
from
the
personal
care
home
three
days
a
week.
They
do
personal
care,
facili
training
with
them.
They
have
group
therapy
individual
session
life
skills,
so
she's
really
like
learning
to
cook
again
and
all
that.
So
we
had
all
that
in
place
for
her,
and
she
was
doing
very,
very
well
like
I
have
been
in
this
family.
F
F
So
my
sister-in-law
is
doing
well
mentally,
but
she
still
does
not
have
the
correct
mind
for
him
to
say
yes
or
no
to
things
that
are
not
good
for
her,
and
so
she
was
presented
with
an
opportunity
to
participate
in
substance
abuse
again
and
took
a
downward
spiral
through
that.
But
it
was
at
that
time
that
my
husband
and
I
realized,
if
she's
in
a
good,
loving
environment,
where
that's
not
an
option
for
her
we've
seen
her
thrive.
F
We
can
see
her
come
back
and
thrive
again,
so
we
decided
then
to
move
her
in
with
us.
So
in
the
end
of
june
she
began
living
with
us.
I
tried
to
move
her
care
from
hopkins
county
to
muhlenberg
county
where
we
live.
I
called
the
local
office
again
explained
the
programs
that
she's
been
involved
in
asked
what
they
had
as
options
to
see.
If
we
could
get
her
transferred-
and
I
was
told
they
had
no
idea
what
I
was
even
talking
about-
and
so
I
don't
know
I
don't
know
the
appropriate
lingo.
F
F
35
minutes
there
either
stay
in
town
or
come
back
home
and
go
pick
her
up
three
hours
later,
and
it
was
then
that
the
psychiatrist
at
that
organization
told
us
that
there
was
another
program
that
I
could
apply
for,
which
was
a
community
integrative
service
and
then
that
would
provide
pacs
with
her
okay,
so
need
to
back
up
a
little
bit
more
also
when
she
moved
in
with
us.
F
F
I
explained
at
that
point
we're
looking
for
an
annual
physical
make
sure
health's
in
check
see
what
any
other
issues
we
need
to
address,
but
really
what's
most
important
is
we
need
that
psychiatric
referral,
and
so
an
appointment
was
made.
We
went
to
it
the
following
week,
I
walk
in
and
I
get
told
that
the
appointment
has
been
canceled.
So
I
start
to
question
because
I
knew
I
hadn't
questioned,
I
hadn't
canceled
it,
and
so
I
didn't
understand
why
I
was
canceled
and
it
was
at
at
that
point.
F
I
was
very
angry
and
very
hurt
and
crushed,
and
I
just
looked
at
the
receptionist
and
I
said
you
know
nobody
deserves
to
be
treated
this
way
like
you
could
have
called
and
told
me
this
over
the
phone,
and
I
would
have
understood
100
and
I'm
like,
but
for
you
to
say
this
not
just
to
me
but
she's
having
to
listen
to
it
and
there's
people
back
behind
us
in
the
waiting
room
that
just
heard
what
you
said
as
well.
I
was
like
you
know.
F
The
only
way
people
are
going
to
get
better
is
if
people
believe
that
they
can
get
better
and
are
willing
to
fight
for
them
on
their
team.
So
I,
though
I
understood
the
background
to
it.
I
don't
understand
the
way
that
it
was
handled,
and
so
eventually
we
were
able
to
get
with
a
very
good
nurse
practitioner
for
the
family
care
and
all
that
was
done.
F
We
still
do
not
have
a
referral.
It's
now.
Three
months
later
and
the
first
referral
was
sent
to
baptist
health
in
madisonville,
which
is
only
an
inpatient
care.
They
don't
have
any
outpatient
care,
but
at
hope
and
healing,
where
she's
doing
the
group
therapies.
They
are
in
connection
with
a
psychiatrist
there.
So
we
have
done
two
televisions
with
her,
but
even
just
last
week
you
know
we
want
to
know
what
our
expectations
can
be.
You
know
like.
F
F
She
was
good
enough
because
she's
taking
a
bath
and
she's
keeping
a
clean
room,
and
so
I
don't
feel
like
my
family's
on
the
same
page
with
her
that
that's
where
we'll
stay,
and
so
that's
something
that
we're
still
having
to
pray
about
as
well,
but
that
you
know
those
are
just
some
of
the
challenges
and
so
there's
just
one
more
and
the
last
thing
was
last
month
we
did
our
medicine
refill.
F
One
of
the
prescriptions
had
to
have
a
prior
authorization.
The
prior
authorization
took
over
10
days
to
get
somebody
that's
on.
A
psychiatric
medication
does
not
need
to
wait
10
days
to
get
a
medicine
and
it
was
a
psychotic
med.
It
was
one
of
her
psychotic
medicines,
and
so
we
were
able
to
pay
for
it
out
of
pocket.
Thankfully,
so
she
didn't
have
to
miss
any
but
she's
also
on
a
fixed
income.
F
So
even
that
was
a
big
hit
for
her
in
that
case,
but
you
know
luckily
she
was
living
with
us,
so
she
didn't
really
have
a
lot
of
other
expenses.
But
you
know
in
in
a
different
situation.
It
could
have
been
a
lot
worse,
and
so
anyway,
as
you
can
see,
dr
shusher
has
highlighted
several
things
aboard
about
the
revolving
door
and
the
unavailability
of
housing.
F
The
lack
of
the
medical
care
and
the
need
for
medicine
formulary
is
all
real
in
our
situation
and
mr
mark
kelly,
he
addressed
the
shortage
of
mental
health
professionals
and,
and
it's
very
terrifying
when
you
need
that
medication
like
it's
not
like,
you
could
go
a
few
days
without
some
of
that
it
could
be
detrimental
to
fight.
He
also
talked
about
the
stigma
so
to
fight
the
stigma
behind
it.
F
It's
not
even
that
they
for
me,
it's
not
even
the
community
that
we
live
in,
but
even
our
doctors
need
to
fight
against
that
and
provide
better
care
and
personalization
because
they
need
to
be
treated
just
like
everybody
else.
Does
dr
alvarado
or
senator
alvarado.
He
repeated
dr
schuster's
concerns
on
the
homelessness,
but
you
know,
as
you
can
see
in
our
story,
it's
not
always
the
case.
You
know
when
we
were
trying
our
hardest
to
find
a
place
forward,
and
we
just
couldn't
find
one.
F
That
would
say
yes
and
we
had
to
take
the
one
that
was
available
and
then
also
you
know,
people
aren't
willing
to
take
the
hard
cases.
That
was
the
main
thing
behind
of
us
that
you
know
I've
not
shared
details
of
her
story,
and
I'm
very
happily
will
with
any
questions
that
you
all
have
to
give
you
good
examples
of
it.
F
But
I
just
wanted
to
use
my
time
on
what
was
you
know
being
faced
upon
this
time,
and
then
you
know
again
the
last
one
was
you
know:
people
say
that
you
should
not
be
turned
down
for
it,
but
when
we
approached
that
we
were
turned
down,
and
so
you
know
whether
we
have
medical
insurance
or
not.
I
mean
mental
health
is
not
a
joke
that
you
want
to
mess
with,
and
it
not
only
can
be
detrimental
for
the
individual,
but
also
the
community
and
the
people
that
they
are
around
them.
F
F
Every
single
step
about
those
that
are
in
the
trenches
and
through
that
education
we've
really
been
able
to
help
her,
but
I
do
think
that
there's
should
be
a
way
that
all
of
it
streamlines
together,
and
so
you
know,
like
one
phone
call,
shouldn't
lead
to
five
others,
and
you
know
one
one:
police
officer
should
not
have
to
stay
with
an
individual
for
several
hours.
That's
already
been
in
in
mental
health
hospitals.
F
Multiple
times
I
mean
it
should
just
be
an
automatic
smooth
process
for
them
to
get
there
and
get
the
treatment.
And
then,
even
today
it
was
mentioned.
You
know
that
that
early
intervention
is
important,
but
even
when
they're
in
psychotic
episode
having
to
wait
in
a
jail
cell
and
allowing
you
an
opportunity
to
bang
your
head
back
into
the
wall
isn't
helpful
for
the
patients
as
they're
in
that
state
as
well,
and
so
I
just
want
to
thank
you
for
your
time
and
for
hearing
my
story
and
again
I
am
open
to
questions.
K
A
You
as
her
advocate
and
if
you
stay
at
the
table,
just
a
few
more
minutes.
If
you
have
time,
there's
some
water
for
you
and
we
have
jayla
nunley.
If
you
would
also
introduce
yourself
and
proceed
yes,
ma'am.
K
A
K
K
When
someone
is
incarcerated
that
has
a
mental
illness,
it
kind
of
it's
kind
of
an
eye
opener
for
us
because,
as
miss
blake
said,
we're
not
trained
to
be
able
to
deal
with
someone
who
has
a
mental
illness.
We
do
have
24-hour
nursing
here
but,
as
you
all
know,
a
nurse
without
special
being
specialized
in
training
for
people
with
mental
illness.
It's
also
a
challenge
for
them.
So
I'm
very
familiar
with
this
blake's
story.
K
We
get
people
in
here
on
a
daily
basis
that
has
said
some
type
of
mental
illness,
some
of
us
drug
psychosis,
but,
as
you
all
know,
it
doesn't
matter
how
they
get
there.
K
K
K
I
think
it
needs
to
be
a
different
avenue,
more
avenues
for
people
when
they're
incarcerated
to
get
the
help
that
they
need,
and
I
think
the
system
is
kind
of
it
is
broken.
It's
the
old
system
we've
used
in
the
past,
things
have
changed
times,
have
changed
and
we're
making
criminals
out
of
people
with
mental
illness.
And
to
me
that's
a
it's
a
shame.
You
know,
I
feel
like
there's
other
ways
that
we
can.
K
L
K
Doing
this,
we'll
we'll
open
up
doors
hopefully
and
make
our
job
easier,
make
law,
enforcement's
job
easier
and
miss
blake
people
like
herself,
that's
going
through
these
things
won't
have
to
go
through
it
in
such
a
such
a
manner.
So
that's
kind
of
where
I
stand
I'll
make
it
brief.
I
know
time's
running
out
and
the
chief
deputy
shoemaker
wants
to
kind
of
elaborate
on
some
things
I
talked
about
also,
so
thank
you
for
your
time.
A
Thank
you
very
much
is
sheriff
ward
also,
there.
L
Is
man
I
am
chief
deputy
wade
schumacher?
I
am
the
obviously
the
chief
deputy
of
millenberg
county,
real
quick
about
myself.
I've
been
in
law
enforcement
for
over
30
years,
but
I've
only
been
with
the
sheriff's
department,
as
the
chief
deputy
for
the
last
11
months
next
month
will
be
a
year.
Didn't
take
me
long
to
realize
how
busy
the
sheriff's
department
is
and
especially
how
busy
we
are
dealing
with
the
mentally
yield.
L
We
are
located
within
penny
royal
mental
health
services
district,
and
I
will
say
that
I
had
a
meeting
sheriff
ward
and
I
both
met
with
the
area
supervisor
audra
hall
a
few
weeks
ago
and
had
a
fantastic
meeting.
She
was
great.
I
think
we
all
realized
and
all
agreed
that
there
was
some
issues
in
the
system
that
need
to
be
addressed,
and
I'm
thankful
for
this
opportunity
to
address
them
here
and
I'm
glad
there's
some
dialogue
been
being
talked
about
to
try
to
improve
the
system.
L
I
think
the
system
has
been
in
place
for
so
long.
It's
basically
accepted
as
that's
just
the
way
it
is,
but
I
think
times
have
changed
like
jayla
nunley
has
said,
and
it's
time
to
to
address
it.
Our
calls
are
an
all-time
high.
Our
calls
for
dealing
with
the
mentally
ill
are
at
an
all-time
high,
real
quick
on
our
protocol,
basically
on
dealing
with
the
mentally
ill.
L
L
If
it's
during
business
hours,
we'll
take
that
person
to
penny
royal
and
I'll
either
do
an
evaluation
in
person
or
more
more
than
likely
it's
over.
It's
a
skype
interview
if
it's
after
hours,
we'll
take
them
to
the
local
police
department,
either
greenville
or
central
city
for
that
skype
interview.
L
L
Processes
take
a
while,
like
I
said
a
couple
hours
and
depending
on
the
results
of
those
evaluations,
were
tasked
with
the
responsibility
of
transporting
them
to
western
state
hospital
or
an
example
I'll
give
that
just
happened.
Last
week
we
had
a
voluntary
walk-in
that
walked
into
the
penny
royal
clinic
in
greenville,
seeking
help
turned
into
being
involuntary
hospitalization.
The
judge
signed
an
order,
and
the
transport
order
was
for
us
to
take
him
to
baptist
health
in
madisonville.
L
The
deputy
first
received
the
call
it
was
about
303
in
the
afternoon,
and
he
didn't
he
didn't,
leave
there
until
9
23
in
the
evening,
so
he
spent
over
six
hours
over
there
and
the
next
day
we
had
to
send
another
deputy
over
there
to
transport
that
same
individual
to
to
western
state.
L
That
occurred
a
few
weeks
ago,
there
was
a
lady
there,
the
intensive
care
unit
at
the
middlebury
county
hospital
they
had
called
said
they
had
a
transport
order
for
us
to
transport
her
to
western
state
when
I
first
walked
in.
I
was
the
one
that
I
was
the
only
deputy
deputy
available
at
that
time,
so
I
walked
in
there
and
she
I'm
not
going
to
say
panic,
but
she
had
a
very
concerned.
Look
on
her
face
and
was
very
apprehensive
was
seeing
me
walk
in.
She
thought
she
was
going
to
western
state.
L
In
fact
she
was,
but
she
was
very
agitated
that
I
walked
in
basically
in
law
enforcement
and
not
somebody
else.
So
I
mean
there's
sometimes
when
dealing
with
a
mentally
ill,
that
I
think
we
could
escalate
the
situation
just
by
people's
views
of
the
police
and
sometimes
again
that
I'm
not
so
sure
law
enforcement
should
be
involved
in
all
the
mental
ill
cases.
L
Again,
I
mean
first
and
foremost,
we
want
to
see
these
people
get
the
help
we
need
that
or
they
need-
and
I
just
want
to
from
the
point
from
the
sheriff's
department.
I
think
it's
the
length
of
times
that
our
deputies
are
tied
up
with
them.
It's
excessive
and
we
had
a
recent
in-service
in
madisonville.
There
was
a
lieutenant
there
from
jessamine
county
sheriff's
department.
L
He
was
we
were
explaining
how
we
dealt
with
mentally
ill,
and
he
was
saying
that
eastern
state
hospital
for
exams
in
our
district-
and
he
says
all
they
need-
is
a
citation
or
a
mentally
ill
warmth.
They'll
take
them
there
and
drop
them
off.
I
would
love
to
see
us
get
there
at
some
point
where
we
could
just
take
them.
Even
if
it's
western
state
transport
them
down
there
and
drop
them
off,
they
get
the
help
they
need
mentally.
L
If
there's,
if
there's
a
problem
with
them
physically
acting
up,
they
have
people
on
on
hand
to
deal
with
them
physically.
So
that's
where
I
hope
to
get.
I
mean
we're
not
there
yet
and
penny
roll
audra.
Like
I
said,
audra
hall
has
been
fantastic
to
deal
with
she
she's
aware
of
the
problems
and
we're
both
taking
steps
forward,
we're
not
where
we
want
to
be
yet,
but
we
hope
to
get
there
hope
to
get
there
soon.
A
Thank
you
so
much
for
your
insight.
If
you
all
could
stay,
we're
gonna
have
some
questions
and
we're
about
over
our
time
limit.
But
I
think
we've
got
really
patient
people
on
this
committee
and
if
they
don't
have
to
go
they'll
stay,
some
has
have
to
go
possibly
representative,
co-chairman,
bentley.
A
G
Okay,
I
just
wanted
to
make
a
short
comment,
and
that
is:
we
had
talked
about
the
mobile
mental
health
in
on
wheels
before
and
with
this
15
million
going
to
20
states
the
mobile
crisis
intervention
that
ms
hoffman
spoke
about.
G
I
want
to
give
people
the
site
to
go
and
read
about
that:
cms.gov
newsroom,
cms.gov
newsroom,
so
the
ideas
that
we've
had
in
this
on
that
mobile
unit
to
help
people
may
be
combined
with
that,
and
so
you
know
that
mobile
mental
health
unit
since
may
of
21
saw
over
220
individuals
who
would
not
go
into
the
building
because
of
the
stigma
of
their
cases.
So
I
just
want
to
bring
that
up
and
we'll
discuss
it
more
later
and
thank
you
chairman
kerr
for
being
considered
to.
Let
me
say
that
thank.
A
D
I
just
want
to
thank
you
all.
I
know
I
felt
like
this
put
a
face,
a
real
life
case
to
what
we've
been
hearing
and
it
just
everywhere
I
went
I
would
hear
from
law
enforcement.
I
don't
hear
from
the
jayla
that
we
really
need
to
address
these
issues,
so
I
thought
it
was
important
to
get
these
voices
heard,
and
I
appreciate
you,
I'm
so
proud
of
you
for
for
your
testimony.
You've
done
an
excellent
job
and
very
professional,
and
thank
you,
gentlemen,
for
being
so
patient
at
home,
and
thank
you.
A
A
I'm
going
to
now
announce
that
our
next
meeting
will
be,
and
if
you
all
would
like
to
come
back
you're
welcome.
It
would
be
october
19th
at
3
pm,
and
at
this
time
I
would
take
a
motion
for
adjournment.