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From YouTube: Severe Mental Illness Task Force 6-15-21
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A
A
F
F
E
A
Cirrus
or
something
I
don't
know,
okay
before
we
begin
with
the
presentations
for
members
participating
remotely,
which
is
the
other
co-chair
remember
to
meet
your
mute,
your
microphone
unless
you're
asking
a
question
so
this
afternoon,
we're
going
to
start
a
presentation
on
severe
mental
illness,
and
we
will
begin
with
dr
schuster,
who
will
be
providing
an
overview
of
community-based
treatment
and
relevant
legislation.
A
G
H
Oh
there
we
go
how's
that
better,
okay.
Thank
you
very
much
and
good
afternoon,
I'm
dr
sheila
schuster
a
licensed
psychologist
and
executive
director
of
the
kentucky
mental
health
coalition.
The
coalition
is
composed
of
over
80
organizations
representing
consumers,
family
members
providers
and
advocates,
and
we
will
be
celebrating
our
40th
birthday
next
year.
I'm
excited
to
be
here
to
speak
with
you
all,
and
I
want
to
thank
coter
bentley
for
inviting
me.
H
The
coalition
and
its
members
also
appreciate
the
efforts
of
representative
kim
moser
in
sponsoring
house
concurrent
resolutions
in
the
past
two
legislative
sessions
to
establish
this
task
force.
We
are
particularly
grateful
to
the
legislative
leadership
in
both
chambers
who
move
forward
to
authorize
the
task
force
to
meet
during
this
interim
session.
H
in
1945.
It
housed
1996
patients.
That
number
was
cut
by
half
to
999
in
1967.
After
federal
legislation
was
passed
in
1963,
the
community
mental
health
act
to
deinstitutionalize
individuals
with
mental
illness.
The
old
eastern
state
hospital
housed
150
patients
in
2007,
so
you
can
see
the
decline
that
came
with
deinstitutionalization.
H
Fortunately,
a
new
state
of
the
art
eastern
state
hospital
was
built
on
the
uk,
cold
stream
property
and
opened
in
2013,
thanks
largely
to
the
unrelenting
advocacy
of
nami
lexington,
who
kept
the
call
for
a
new
hospital
alive
for
many
years
until
it
became
a
reality
for
those
of
you
not
familiar
with
nami
and
ami.
It's
the
national
alliance
on
mental
illness,
and
we
will
mention
their
advocacy
work
frequently
during
our
presentations
because
they
are
really
the
on-the-ground
folks.
They
are
largely
the
family,
members
and
consumers
around
people
with
severe
mental
illness.
H
So
what
happened
in
the
1960s,
when
we
had
huge
numbers
of
people
with
severe
mental
illness
and
other
disabilities
suddenly
turned
out
of
the
institutions
and
into
the
community
me
when
I
say
we
are
still
grappling
with
that
question.
We
still
have
not
completely
dealt
with
all
of
the
issues
that
those
folks
had
when
they
were
let
out
if
you
will,
or
dumped
out
or
turned
out
or
released,
or
whatever
words
you
want
to
use.
H
We
had
the
community
mental
health
act
and
at
that
time-
and
some
of
you
have
heard
me
say
this
in
previous
testimony-
kentucky
was
number
one
in
the
nation
think
about
that.
We
were
the
very
first
state
to
take
that
federal
legislation
and
turn
it
into
state
legislation
krs-210
to
establish
a
statewide
network
of
community-based
mental
health
centers.
H
They
used
to
be
called
mental
health
mental
retardation
boards.
Of
course,
we
don't
use
the
term
mental
retardation
anymore,
but
that
was
their
original
title
because
they
not
only
were
authorized
under
210
to
take
care
of
people
with
mental
illness,
but
also
people
with
developmental
and
intellectual
disabilities.
H
We've
called
them-
and
you
all
have
called
them
cmhcs
for
years
and
years,
and
I'm
delighted
that
you
have
two
great
representatives
from
the
cmhcs
here
to
talk
after
I
talk
because
you
really
need
to
get
that
on
the
ground
perspective,
so
we
were
number
one
in
laying
out
that
statewide
network.
I
was
not
even
in
kentucky
at
that
time,
but
I
came
in
1970
and
I
began
to
realize
how
important
that
was.
The
other
thing
that
I
benefited
from.
H
I
was
finishing
my
doctoral
training
at
the
university
of
louisville
and
I
needed
to
complete
a
full
year's
internship
to
get
my
doctoral
degree,
and
I
was
able
to
put
an
internship
together
with
what
was
then
river
region
is
now
seven
counties
and
what
I've
come
to
understand
is.
This
is
important
for
you
all
to
know.
The
cmhcs
have
trained,
probably
thousands
of
mental
health
providers
of
every
kind,
psychiatry,
psychology,
social
work,
counselors,
every
kind,
they've
done
it
through
internships
and
through
supervised
practica.
H
So
so
many
people
that
you
know
as
providers,
whether
they're
providers
in
private
practice
or
they
stayed
in
the
system.
Most
of
them
got
their
training
and
then
left
the
system.
Unfortunately,
but
without
the
cmhcs,
our
scarcity
of
behavioral
health
providers
that
senator
alvarado
talks
about
so
often
that
faucet
would
have
been
down
to
a
drip.
I
mean
we
literally
would
not
have
even
the
number
of
providers
that
we
have
now.
So
it's
a
very
important
role
that
they
have
played.
H
The
other
unfortunate
thing
is
that
if
you
ask
me
now,
where
kentucky
ranks,
we
were
number
one
we're,
probably
45th
or
46th
in
terms
of
the
funding
per
capita
on
mental
health.
We
also
are
one
of
the
few
states
in
the
country
that
received
f
scores
from
nami
national
when
they
graded
our
mental
health
system.
H
So,
what's
that,
what's
one
of
the
things
that
we
spend
most
of
our
time,
thinking
about
worrying
about-
and
this
will
hit
you
right
in
the
heart
representative-
bentley-
because
it's
medications-
you
know
the
most
progress
that
has
been
made
in
the
treatment
of
people
with
severe
mental
illness-
has
been
around
medications.
H
H
Electro-Convulsive
shock
therapy
ect
was
done
with
a
schedule
instead
of
pinpoint
accuracy
which
is
being
done
now.
So
we
really
didn't
know
a
lot
about
what
constituted
a
severe
mental
illness
and
we
weren't
very
good
at
treating
it.
The
kinds
of
advances
that
have
been
made
in
medications
have
been
incredible,
and
I
know
that
we're
going
to
have
a
board-certified
psychiatric
pharmacist
presented
at
a
later
time,
and
I
think
that
will
be
great
for
you
all.
H
H
Another
is
tardive
dyskinesia,
which
is
unwanted
motor
activities,
there's
even
a
ad
on
television.
Have
you
seen
that
recently
for
a
new
medication,
for
I
thought
nobody
talked
about
dyskinesia
except
in
the
mental
health
clinics,
but
that's
how
common
those
side
effects
are,
and
you
will
hear
if
you
ever
talk
to
people
with
serious
mental
illness
or
their
family
members,
they
will
say
I
don't
feel
like
it's
me.
I
don't
feel
like
I
can
be
creative.
I
don't
feel
like.
H
I
can
function
when
I'm
on
my
medication,
so
that
adherence
sometimes
called
compliance
which
I
hate,
because
it
makes
it
sound
like
people
are
willfully
making
a
decision
not
to
be
compliant
like
an
errant
child,
and
that
really
is
not
the
case.
So
we
really
need
to
be
looking
at
medications.
One
of
the
wonderful
advances
has
been
what
we
call
long-acting
injectables
they're,
very
common
now
for
a
30-day
period.
So,
instead
of
the
person
having
to
remember
to
or
be
willing
to
take
a
medication
every
day
for
30
days,
they
can
have
one
shot.
H
H
A
lack
of
psychiatric
prescribers
and
again
senator
alvarado
has
spoken
to
that
eloquently.
So
we
have
psychiatrists.
We
have
very
limited
numbers
of
child
psychiatrists.
We
have,
fortunately,
a
growing
number
of
psychiatric
or
mental
health
nurse
practitioners.
More
programs
are
are
developing
that,
but
you
will
ask
the
cmhcs
here
behind
me:
what's
their
hardest
staff
to
get
in
its
psychiatrist.
H
And
then
we
have
the
adherence
issue
as
well.
There
have
been
a
number
of
pieces
of
legislation
to
to
deal
with
this
back
in
the
early
2000s.
We
added
a
second
psychiatrist
to
the
medicaid
p
t
committee.
They
call
it
the
pharmacy
and
therapeutics
committee.
We
wanted
to
be
sure
that
we
had
a
community-based
psychiatrist
who
could
look
at
those
medications
and
really
determine
their
efficacy
and
decide
what
should
be
on
the
on
the
approved
drug
list.
H
We
also
had
a
wonderful
bill
passed
in
2020
sb
150,
to
create
a
single
formulary
for
medicaid.
We
have
been
advocating
for
that
in
the
behavioral
health
community
ever
since
we've
had
mcos,
because
what
do
you
have-
and
I
know
senator
meredith
knows
this-
every
mco
has
a
different
formulary.
Every
mco
has
a
different
rule
set
of
rules.
Every
mco
has
a
different
way
to
do
prior
us
and,
of
course
the
prescriber
doesn't
always
know
when
the
person
comes
in
or
can't
keep
track
of,
what's
on
their
pharmacy,
formulary,
pdl
and
so
forth.
H
So
that
went
into
effect
january
1st,
and
I
would
not
lie
to
you
by
saying
it's:
it's
been
heavenly
because
it
has
not
been
we've
had
our
our
ups
and
downs
with
it,
but
I
will
tell
you
that
the
medicaid
folks,
the
pharmacy
folks,
dr
joseph,
before
he
left
and
his
replacement
now
dr
ali,
have
been
very
helpful
in
working
with
us
they're
trying
to
ease
everybody
into
this
single
formulary,
and
I
think,
by
the
end
of
the
year,
when
we
get
that
worked
out.
That
will
be
a
godsend.
H
At
least
everybody
will
know
what
are
those
psychiatric
medications
that
are
on
the
on
the
preferred
drug
list
and
which
ones
are
not,
and
what
are
the
over-the-counter
medications?
So
that's
very
important.
H
I
also
want
to
point
out
that
we've
developed
some
other
treatments
besides
medication,
one
that
I
would
call
your
attention
to
is
called
cognitive
enhancement,
therapy
or
cet,
it's
being
done
beautifully
at
bridgehaven
mental
health
services
in
louisville
and
particularly
with
newly
diagnosed
younger
patients,
and
I
would
suggest
that
you
might
have
somebody
from
bridgehaven
come
and
present
to
you.
That's
an
evidence-based
treatment.
That's
really
proving
to
be
very
successful
payment.
H
You
know,
prior
to
1964,
everybody
was
in
the
hospital,
so
the
state
was
paying
for
all
those
folks
once
they
got
out
in
the
community
and
krs-210
was
established,
the
community
mental
health
centers
could
build
medicaid,
and
that
was
a
godsend,
of
course,
and
medicaid
is
much
more
flexible,
as
you
all
know,
than
private
insurance
in
terms
of
the
range
of
services
that
it
will
cover.
H
So
it
covers
not
only
the
diagnosis
and
the
medications
and
the
therapy,
but
it
also
covers
what
we
call
targeted
case
management,
which
is
probably
the
glue
that
holds
the
system
together.
It's
those
people
that
can
keep
in
touch
with
the
person
and
know
what
they
need
for
their
next
kind
of
service
delivery.
H
It
also
includes
people
that
we've
developed
called
peer
support.
Specialists,
who
are
people
with
the
lived
experience
of
having
a
severe
mental
illness,
have
been
in
recovery,
have
been
trained
and
certified
by
the
state
and
now
are
billable
thanks
to
the
advocacy
of
the
behavioral
health
community
and
the
legislature
are
billable
to
medicaid.
H
Some
of
you
may
know
that
we
have
peer
support
specialists
over
on
the
mental
health
side.
We
also
have
them
on
the
substance,
use
disorder
side
which
I'm
sure
senator
alvarado
is
familiar
with
and
again.
These
are
folks
that
know
when
a
crisis
is
coming
very
often
they
can
get
to
the
person
and
get
them
redirected
or
get
them
into
services.
So
those
are
some
of
the
treatment
enhancements
that
we
have.
H
We
also
have
perfected
and
I'm
sure
that
either
steve
or
mark
will
talk
about
assertive
community
teams,
action
teams
that
reach
out
and
particularly,
are
hooked
up
with
our
people
with
severe
mental
illness,
to
try
to
make
sure
that
they're
taking
their
medication.
They're
getting
to
their
therapy,
appointments
and
and
so
forth
in
2011,
the
payment
structure
here
in
kentucky
changed,
and
I
will
say
for
one:
it
did
not
change
for
the
better.
H
That
was
when
the
first
bashir
administration
brought
in
the
managed
care
organizations-
and
I
don't
know
if
some
of
you
may
remember
at
that
time,
but
the
behavioral
health
community
fought
hard
really
hard
to
be
carved
out.
As
this
happened
in
other
states,
you
know
we're
a
tiny
portion,
I
think
no,
no
more
than
three
percent,
probably
less
than
three
percent
of
the
total
medicaid
spending
budget,
and
yet
we
feel,
like
our
people,
really
need
special
attention.
It's
not
just
a
matter
of
dollars.
H
It
has
been
a
battle
I
mean
I
will
not
lie
to
you
and
I
know
senator
meredith
has
has
lobbied
for
fewer
numbers
of
mcos
and
so
forth,
but
the
things
that
we
told
them
when
they
first
came
in
2011
people
need
to
have
access
to
their
medication.
When
it's
prescribed
people
need
to
be
able
to
go
to
the
hospital
if
that's
where
they
need
to
go,
and
consumers
and
family
members
need
to
be
a
part
of
your
decision
making
need
to
be
on
your
advisory
committees
and
so
forth.
H
H
Why
can't
we
get
targeted
case
management
for
our
people
with
severe
mental
illness,
to
keep
them
out
of
homelessness,
to
keep
them
out
of
jail
to
keep
them
out
of
recidivism
back
to
the
hospital
and
the
mcos
turn
it
down
and
turn
it
down
and
turn
it
down?
And
I
don't
know
if
you're
aware
of
it,
but
medicaid
has
suspended
all
prior
authorizations
for
behavioral
health
and
when
I
use
behavioral
health,
I'm
talking
about
both
mental
health
and
substance
use
disorders,
so
we're
in
a
real
quiet,
protected
period.
H
Right
now,
in
addition
to
that,
she
has
given
us
access
to
the
data
managers
over
at
medicaid
so
that
they
can
pull
data
to
see
what
actually
has
been
the
effect
of
targeted
case
management
on
people
with
severe
mental
illness,
and
we've
had
several
conversations
with
them.
We're
trying
to
narrowly
define
and
make
sure
that
we
ask
for
things
that
are
gettable
in
the
database,
but
also
can
show
us
what
the
successes
have
been
and
she
has
been,
and
her
staff
have
been
right
there
with
us
every
step
of
that.
H
So
I'm
very
encouraged
by
that
and
I'm
hoping
that
we
can
move
behind
beyond
just
fighting
with
the
mcos
over
every
every
piece
of
service
or
supports.
We.
You
all
have
also
passed
bills
representative
fleming
back
in
2018,
around
centralized,
credentialing
and
and
the
medical
necessity
criteria
that
we're
still
working
on
trying
to
get.
We
love
senator
meredith
senate
bill
55
to
get
rid
of
the
co-pays
in
medicaid.
H
I
have
actually
argued
to
medicaid
and
to
the
mac
that
people
with
behavioral
health
ought
to
get
paid
for
keeping
their
appointments
and
taking
their
medication,
and
they
shouldn't
be
dinged.
Literally,
that's
what
I've
recommended
you
know
we
ought
to
be
reinforcing
people
for
doing
what
they're
supposed
to
be
doing
when
it's
so
hard
for
them
to
do
that.
So
I'm
thrilled,
as
you
know,
senator
meredith
with
those
medicaid
co-pays
going
away.
H
You
know
I
mean
these
people
have
emotions
around
those
things
as
well
and
they
don't
want
to
be
embarrassed.
They
don't
want
to
be
asked
for
three
dollars
and
have
to
say
no.
I
don't
have
that,
and
our
community
mental
health
centers
and
most
of
our
behavioral
health
providers
did
not
ever
turn
anybody
away,
but
the
individual
didn't
always
know
that
and
so,
rather
than
to
run
into
that
they
would
just
stay
away.
H
So
that's
one
issue.
The
other
issue
is
quite
frankly
and
not
to
point
fingers,
but
the
medical
community,
the
physical
health.
Let
me
call
it
community,
because
it's
not
certainly
just
physicians
but
all
of
what
we
think
of
as
the
physical
health
community
find
it
hard
to
deal
with
our
folks,
I
mean
I'll,
tell
you
my
daughter's
a
nurse
at
a
family
health
center
in
louisville
and,
more
than
once,
she
has
called
me
to
say
what
should
we
do
with
this
behavior
in
our
waiting
room?
H
You
know
we
want
to
serve
this
person,
but
they're
scaring
the
other
people
that
are
here
and
and
so
forth,
and
what
should
we
do
so?
There's
there's
that
problem
as
well.
The
other
thing
is
that
our
folks
get
used
to
coming
say
to
the
community
mental
health
center.
They
know
people
there
that
feel
safe
to
them.
H
It's
very
very
hard
to
get
them
to
go
someplace
else
and
to
start
that
process
new
again
and
to
have
to
say
to
somebody
yeah,
I
have
schizophrenia
or,
yes,
I've
been
diagnosed
with
bipolar
disorder,
so
the
cmhcs
finally
got
some
legislation
passed
in
2014
to
allow
them
to
have
a
non-psychiatric
physician
at
the
mental
health
center.
So
it
was
under
one
roof.
It
was
integrated.
In
that
sense
they
could
get
both
physical
health
and
mental
health
care.
H
H
We
think
that
probably
the
smi
population
is
somewhere
between
two
and
a
half
percent
and
four
percent,
but
we
also
know
that
many
of
them
do
not
get
treatment
when
they
need
treatment
first,
when
they're
first
diagnosed
or
could
be
first
diagnosed,
and
many
of
them
get
into
treatment
via
law
enforcement,
quite
frankly,
because
they
have
acted
in
a
way
or
come
to
the
attention
of.
H
We
have
involuntary
commitment
here
in
kentucky.
It
was
passed
in
1982.
You
all
have
heard
it
referred
to
as
krs-202a
it's
a
very
strict
set
of
criteria
stricter
than
in
many
other
states.
We're
very
aware
of
the
issue
of
when
do
you
go
against
somebody's
will
and
force
them
to
do
something
that
they
really
don't
want
to
do
at?
What
point?
Do
I,
as
a
psychologist,
judge
that
this
person
is
not
capable
of
making
a
rational
decision
about
their
care
about
their
needs,
and
so
we
have
instituted
the
202a.
H
So
many
of
your
nami
family
members
are
quite
familiar
with
having
to
go
down
to
the
district
courthouse,
take
out
what
they
call
a
mental
inquest
warrant,
an
miw
and
have
the
judge
rule
that
the
person
should
be
picked
up.
The
sheriff
or
law
enforcement
goes
out
and
picks
up.
The
person
takes
them
to
the
local
state,
psychiatric
hospital
law
enforcement
hates
to
do
those
runs
because
they
have
to
wait
there
until
some
decision
is
made,
and
sometimes
the
person
doesn't
get
seen
right
away.
H
We've
tried
to
build
in
some
safety
in
terms
of
having
only
qualified
mental
health
professionals,
we
call
them
qmhps,
so
they're
your
psychiatry,
psychologists,
social
workers
and
so
forth.
We
have
some
experience
with
these
folks
and
they're
held
for
a
72-hour
period,
at
which
time
then
there's
a
court
hearing
and
they
might
be
held
for
a
longer
period
of
time.
H
H
They
would
be
sent
out
with
enough
of
their
medication
to
sustain
them,
usually
seven
days
or
14
days,
and
we
would
have
what
we
call
a
warm
handoff
to
the
community,
so
the
community,
usually
the
community
mental
health
center,
would
be
there
pick
the
person
up
make
sure
that
they
get,
and
this
is
where
your
peer
support
specialists
are
very
important
to
be
there
on
on
the
job.
I
would
love
to
be
able
to
tell
you
that
it
works
that
way.
H
H
H
Mechanism
for
picking
up
these
people
back
in
2007
there
was
additional
funding
put
into
the
community
mental
health
centers
with
a
program
called
diverts
direct
intervention,
vital
early,
responsive
treatment
system.
It
was
in
the
ernie
fletcher
administration.
Mark
birdwhistle
was
the
secretary
of
the
cabinet,
and
it
was
a
really
neat
project
did
not
take
that
many
dollars
and
the
cmhcs
then
had
the
wherewithal
to
really
follow
up
to
be
at
the
front
door
of
the
state
hospital
when
the
person
was
released
and
get
them
into
that
warm
handoff
and
so
forth.
H
We've
had
other
issues,
we've
had
crisis
stabilization
units
that
were
funded
back
in
2002,
eight
bed,
units
for
adults
and
eight
bed
units
for
children.
Unfortunately,
the
funding
was
done
with
every
one
of
the
14
community
mental
health
center
regions,
getting
the
same
number
of
beds,
which
doesn't
make
a
lot
of
sense.
H
If
you
think
about
a
million
people
in
seven
counties
and
50
000
in
comprehend,
up
in
maysville,
you
know
so
an
additional
csu
unit
was
actually
put
in
in
louisville
and
in
memory
of
a
gentleman
I'll
tell
you
about
in
a
little
bit.
So
you
all
have
heard
me
talk
on
and
on
about
the
revolving
door.
H
So
our
people
with
smi
are
the
best
examples
of
people
that
get
stabilized
that
medication,
for
whatever
reason
they
quit
taking
their
medication
or
they
go
to
get
the
next
refill
and
it's
not
there.
They
stop
taking
it.
They
get
into
trouble
with
their
behavior,
with
their
lack
of
ability
to
understand
reality
and
to
make
sound
decisions.
H
They
get
under
a
mental
inquest
warrant.
They
get
back
to
the
hospital
and
you
get
into
that
revolving
door
or
even
worse,
they
get
into
trouble
with
the
law
they
get
put
in
jail
or
prison,
and
you
know
you've
seen
these
statistics.
We
have
more
people
with
mental
illness
in
our
jails
and
prisons
than
we
do
in
our
psychiatric
hospitals,
and
that's
true
in
kentucky
it's
true
in
every
state
in
the
nation
and
that's
just
an
abysmal
state
of
affairs.
H
H
We've
had
problems
in
the
jails
with
suicides
back
in
2000,
the
courier
journal
ran
a
series
of
articles
about
the
number
of
suicides
in
the
jails
and
our
department
of
behavioral
health
really
got
into
action.
They
contracted
and
it's
a
program
that
still
is
operational
with.
It
used
to
be
bluegrass
mental
health
centers,
now
new
vista,
where
they
run
a
triage
line,
that's
available
to
every
jail.
H
You
have
a
qualified
mental
health
professional
who
can
screen
those
calls
tell
them
whether
they
think
the
person's
a
suicide
risk
or
not
needs
to
be
put
on
suicide
watch,
and
then
a
referral
is
made
to
the
community
mental
health
center
in
that
area
to
get
in
touch
with
the
jail
and
so
forth.
So
we've
patched
together
with
the
help
of
the
legislature
over
the
years.
You
know
this
problem
pops
up
or
we
have
a
death.
H
Unfortunately,
these
things
come
from
bad
things
happening
to
good
people,
and
so
we
say:
oh
okay,
we
got
to
take
care
of
that,
so
we
run
over
and
we
do
a
program
and
sometimes
the
funding
gets
sustained
and
sometimes
it
doesn't.
But
the
problem
doesn't
go
away.
You
know
when
these
people
were
put
out
of
the
hospital
into
the
community,
they
were
not
obviously
cured
or
treated
even
and
so
we've
really
not
done
a
good
job
of
doing
a
comprehensive.
H
H
H
So
he
lived
by
himself
in
lexington,
supported
by
his
parents
and
his
family,
who
kept
in
touch
with
him,
he'd
die,
and
so
she
would
go
down
to
the
lexington
district
court
and
take
out
a
mental
inquest
warrant.
The
sheriff
would
come
put
him
in
handcuffs
in
the
back
of
the
car.
Take
him
to
that
second
oldest
eastern
state
hospital,
where
it
was
freezing
in
the
winter
and
burning
up
in
the
summer,
and
it
looked
like
something
out
of
dracula
movies.
H
H
So
we
decided
to
do
something
about
it
and
tom
birch
excuse
me
was
chair
of
the
health
and
welfare
committee
at
the
time
and
did
yeoman's
work.
We
met
for
about
16
months
with
everybody
and
their
brother
and
sister,
one
of
those
meetings
where
consumers
and
family
members
and
protection
and
advocacy
and
the
public
defenders
and
the
lawyers
and
the
comp
care
centers
and
everybody
trying
to
come
up
with
something
that
would
address
that
problem
without
abrogating
the
people's
rights
and
we
came
up
with
tim's
law.
H
We
have
the
strictest
criteria
of
any
assisted,
outpatient
treatment
program
in
any
of
the
states,
because
we
wanted
to
cast
a
narrow
net,
a
small
net.
We
didn't
want
to
scoop
up
everybody
who
had
ever
been
diagnosed
with
a
mental
illness,
so
they
have
to
have
a
diagnosis
of
a
serious
mental
illness.
H
H
So
tim,
instead
of
just
going
to
the
hospital
and
coming
back
home
and
falling
apart
again,
would
have
to
go
to
the
courthouse
and
report
to
a
judge
who
had
a
court
worker
an
additional
layer
of
people,
kind
of
keeping
track
of
him
and
would
get
the
report
from
the
act
team.
He
didn't
let
us
in
again,
we
think
he's
not
taking
his
medication
and
they
would
bring
him
back
to
court
with
a
stern
warning
and
so
forth.
H
You
know
you
don't
want
to
go
back
to
the
hospital
as
much
the
same
way
that
the
drug
courts
are
are
working
in
terms
of
you
know.
Let's
divert
you
into
into
treatment,
so
it
finally
passed
in
2017
with
senator
julie,
rocky
adams,
taking
it
on
was
nearly
unanimous
and
then
governor,
governor
bevin,
vetoed
it.
H
Unfortunately,
no
funding
was
put
in
there
and
there
is
cost
to
this
with
a
court
worker
assigned
to
the
judge's
chambers
and
so
forth,
and
so
there's
actually
only
been
that
we
know
of
one
case
where
tim's
law
has
been
actually
used.
Judge
stephanie,
burke
and
you
may
want
to
have
stephanie
berg
come
and
talk
with
you,
representative
bentley,
because
she's
been
on
this
from
the
very
beginning.
Did
it
in
2019
and
it's
been
hugely
successful.
H
There
is
light
at
the
end
of
the
tunnel,
our
department
of
behavioral
health,
applied
for
and
got
a
samsa
grant.
That's
the
substance,
abuse
mental
health
services
administration,
a
multi-year
grant
and
they
are
rolling
out
tim's
law
in
the
comm
care
center
districts
that
are
served
by
western
state
hospitals.
So
that's
western
kentucky
and
also
seven
counties
that
serve
by
central
state.
So
I
would
think
you
might
want
to
have
somebody
from
the
department
for
behavioral
health
come
and
talk
to
you
about
how
they've
implemented
that
funding
and
how
they
are.
H
Seeing
this
you
know,
put
tim's
law
into
effect.
We
really
need
more
funding
to
take
it
statewide.
It
really
is
a
model
that
I
think
would
get
people
the
whole
idea
of
it
is
to
get
people
stable
on
their
medications
long
enough
that
they
have
kind
of
an
aha
moment
and
begin
to
see
that
taking
their
medication
and
sticking
with
treatment
actually
gets
them.
Someplace
is
a
good
thing
for
them.
H
H
We
knew
that
he
was
in
trouble
and
we
couldn't
figure
out
how
to
take
care
of
him,
and
that
is
so
often
the
case
with
our
folks
with
severe
mental
illness.
We
know
we
know
that
bad
things
are
going
to
happen
and
we
don't
have
a
strong
enough
safety
net
to
gather
these
people
up.
So
tim's
law,
I
think,
is
good.
Am
I
just
running
way
over
in
time
mental
health
courts?
H
There
are
four
of
them
right
now
in
kentucky
up
in
boone,
county
lexington,
louisville
and
e-town.
Unfortunately,
there's
never
been
a
systematic
approach
to
getting
mental
health
courts
there.
H
I
think
it
would
be
great
to
have
the
most
recent
one
was
established
in
lexington
and
that's
nobbing
lexington,
kelly
and
phil
gunning
and
those
folks,
and
they
started
it
on
a
shoestring.
They
got
local
funding
from
metro
lexington.
They
got
a
judge
who
volunteered
his
services
and
they
have
made
this
thing
work
for
the
last
three
years.
I
mean
it
would
really
be
it's
a
success
story,
except
we
shouldn't
be
doing
business.
That
way,
you
know
kind
of
tied
together
with
you
know,
a
wish
and
a
hope,
but
mental
health
courts.
H
I
think
the
judges
would
say-
and
certainly
the
family
members
and
advocates
would
say,
are
really
a
good
thing
because
they
catch
people
before
they
would
be
sent
off
to
jail
or
prison
and
get
them
diverted
into
treatment.
And
that
really
is
a
is
a
model.
It's
also
a
model
for
a
program
called
cit
crisis
intervention.
Team
training
started
in
louisville
when
a
man
with
a
serious
mental
illness
was
running
around
in
chickasaw
park
naked.
I
think,
and
harassing
people
and
the
police
came
and
ended
up,
shooting
him
40
some
odd
times.
H
That
time
was
a
gentleman
named
jim
daly
and
he
had
heard
about
the
cit
program
starting
in
memphis,
and
he
went
down
to
memphis
and
met
with
those
folks
and
brought
them
back
to
louisville
and
louisville
started
the
first
crisis
intervention
team
training
it
has
since
been
in
statute
since
2007.,
it's
housed
at
the
state
training
facility,
and
it
includes
not
only
local
law
enforcement,
but
also
our
kentucky
state
police
and
then,
in
this
past
session,
representative
banta
had
a
bill
house
bill.
44
that
extended
it
to
firefighters.
H
The
other
problem
that
we
have
is
that
we
do
have
people
that
commit
serious
crimes
who
have
a
mental
illness
and
right
now,
kentucky
still
holds
those
people
with
the
possibility
of
the
death
penalty.
H
Now
kentucky
and
the
supreme
court
has
acted
to
preclude
other
populations
of
people
from
the
death
penalty.
One
are
people
with
intellectual
developmental
disabilities
who
don't
have
the
cognitive
ability
to
understand
what
they've
done.
The
other
are
youth
and
house
bill
148
in
the
past
session,
passed
the
house
and
passed
a
senate
judiciary
committee,
but
wasn't
called
for
final
vote.
I
think
we
owe
it
to
these
people
who
do
not
have
the
mental
capacity
to
understand
their
actions
at
the
time
that
they
are
in
a
psychotic
state
to
save
them
from
the
death
penalty.
H
I
will
tell
you
that
family
members
worry
worry,
worry
about
that,
because
they
have
seen
their
folks
be
off
their
medication
and
and
get
angry,
and
they
worry
that
they're
going
to
do
something
to
harm
somebody,
but
they're
also
worried
that
they
could
be
put
to
death.
The
other
thing
that
we
you
want
to
really
look
at
is
housing.
H
Think
about
this.
People
were
housed
in
these
huge
state
hospitals
and
we
opened
the
doors
and
put
them
out
in
the
community.
We
didn't
do
anything
about
housing,
I
mean
we
really
didn't,
have
a
plan
for
housing
them
and
unfortunately,
medicaid
does
not
provide
housing,
does
not
have
a
residential
option,
so
housing
is
so
important
and
it's
not
just
having
a
roof
over
your
head.
It's
having
housing
with
a
little
bit
of
support
somebody
who's
going
to
check
on
you
is
going
to
make
sure
that
you
know
things
are
going.
H
Many
of
our
folks
end
up
homeless,
and
so
you
have
the
homeless
and
housing
coalition
of
kentucky,
there's
also
a
homeless
coalition
in
both
lexington
and
louisville.
That
could
talk
about
some
of
the
things
that
they've
tried
to
do
again:
getting
housing
and
getting
supported
housing.
The
other
thing
is
that
our
consumers
have
made
great
strides.
H
H
H
H
I
urge
you
to
be
open
to
input
from
those
consumers,
individuals
living
with
severe
mental
illness
from
their
family
members
and
from
providers,
hopefully
a
purposeful,
meaningful
reform
and
system
that
needs
to
be
comprehensive.
It
needs
to
be
all
inclusive
and
I
will
quit
talking
and
answer
any
questions
that
you
might
have.
I
appreciate
your
indulgence.
A
A
H
A
A
And
co-chair
kerr,
do
you
have
a
question
since
you're?
Only
one
I'll
ask
you
first.
F
Thank
you,
mr
chairman.
I
do
have
a
question
and
I
thank
you.
Dr
schuster
appreciates
so
much
your
time
and
expertise
and
your
perseverance,
my
goodness,
all
these
years,
that
you
have
worked
on
these
issues,
and
it
makes
me
so
sad
to
hear
that
we've
gone
from
number
one
or
two
to
number
45
or
46,
and
that
we
go
from
good
grades
to
having
an
f
and
when
it's
only
such
a
small
subset
of
our
population
that
has
severe
mental
illness
that
that
we
should
do
better.
We
should
do
better.
F
Tell
me
about.
Is
it
a
vicious
cycle
as
to
why
we
can't
get
psychiatrists
or
is
psychiatry?
Is
this
something
that's
going
on
nationwide?
Is
it
because
of
the
disparity
between
mental
health,
insurance
and
physical
health
insurance
and
so
nobody's
going
into
psychiatry
anymore,
or
where
are
these
people
to
help.
H
H
I
think
what's
happening
at
least
for
the
comp
care
centers
senator
kerr
is
that
if
they
get
a
psychiatrist
that
they
can
talk
to
quite
frankly,
they
often
cannot
afford
to
hire
them
because
they
can
really
name
their
name
their
price,
and
I
don't
know,
I
know
that
representative
moser's
son
is
going
into
psychiatry,
so
we've
all
cheered
that,
but
I
was
trying
to
get
him
into
child
psychiatry.
Actually,
but
right,
I
don't
know
I
you
know.
Maybe
senator
alvarado
has
some
responses
to
that,
because
he
certainly
has
talked
eloquently
about
that.
F
H
My
guess
is
it's
national.
You
know
the
other
problem
that
you
have
senator
kerr
and
I'll
just
say
this:
we
have
lots
of
rural
areas
in
kentucky
and
we
have
trouble
getting.
I
know
for
a
fact
that
you
have
very
few
doctoral
level
psychologists
in
the
rural
areas,
for
instance,
and
we're
not
prescribers,
but
we
do
supervise
a
number
of
other
mental
health
providers
and
and
services
and
the
number
of
phd
level
psychologists
in
the
rural
areas.
So
some
of
this
is
a
rural
urban
kind
of
issue
as
well.
B
Yes,
senator
kerr,
so
I
can
that's
part
of
my
comment
too.
I
think
there's
a
total
right
now
looked
at
these
statistics.
I
was
on
an
ncsl
call
yesterday
regarding
this
issue
about
30
000,
total
psychiatrists
in
the
country
about
15
million
people
with
severe
mental
illness
and
we're
talking
people
with
schizophrenia,
severe
mental
illness.
B
You
know
as
a
primary
care
doctor
I've
gotten
used
to
handling
mild
to
moderate
psychiatric
illnesses
because
you
have
to
there's
just
no
psychiatrist
available.
So
often,
if
you
refer
somebody
for
a
psychiatric
evaluation,
you
have
to
wait
sometimes
months
for
that
person
to
be
seen.
B
You
know
we
have
pathways
programs
and
different
kinds
of
programs
locally.
Those
psychiatrists
come
in
our
community,
they
set
up
shop,
they'll,
see
people
for
a
couple
of
years
are
overwhelmed
and
burn
out
and
leave
is
what
we
often
will
see
so
you'll
get
somebody
if
you
have
a
new
psychiatrist
opens
up
shop,
they'll,
be
full
in
six
months.
Guaranteed
and
they'll
be
done
taking
new
patients
on
so
you
can
fill
them
up
as
quickly
as
you
can
get
them
in,
and
it's
a
struggle
for
a
lot
of
primary
care
docs.
B
B
Now,
a
professor
at
the
university
of
california
irvine
robert
mccarron
who's,
a
guy
that
went
to
rush
medical
school
in
chicago
he's,
double
boarded
internal
medicine
and
in
psychiatry
and
he's
a
program
director
for
a
psychiatric
program
for
residents
over
in
at
uc
irvine
they've
established
a
program
at
uc
irvine
to
try
to
train
rural
health
providers
to
handle
severe
mental
illness
issues,
and
the
general
assembly
in
california
has
allocated
funds
for
that
purpose.
To
help
that
person
reach
out
through
zoom
calls
through
and
earn
a
certificate.
B
If
you
will
for
a
lot
of
those
primary
care
doctors
to
handle
that
what
keeps
a
lot
of
primary
care
dogs
from
managing
people
with
severe
mental
illness
is
just
really
liability
fears.
You
know
the
biggest
risk.
Anybody
with
psychiatric
illness
is
going
to
be
suicide.
So
if
someone
does
that
it
puts
those
those
crosshairs
directly
on
you
from
a
liability
angle,
we
know
that
in
this
state
we
have
a
major
liability
problem.
I've
been
advocating
for
that,
since
I've
been
in.
B
You've
got
schizoaffective
personality
disorders.
Things
are
much
more
difficult
to
handle.
I
don't
know
what
to
do.
I'm
scared
to
handle
it.
I
don't
want
to
give
people
any
psychotics
and
you're
trying
to
find
a
specialist,
and
often
you
can't
find
them.
So
again,
we've
got
a
major
shortage
of
30
000
people
in
this
state.
I've
talked
about
child
psychiatry.
We
train
child
psychiatrists,
the
university
of
kentucky.
We
have
two
slots
per
year
and
those
people
that
go
into
a
five-year
program.
They
train
in
pediatrics,
general
psychiatry
and
pediatric
psychiatry
all
three.
B
It's
a
five-year
program,
two
slots
per
year
and
those
folks
like
you,
said
dr
schuster
named
their
price.
They
go
wherever
they
can
go,
they
get
up.
You
know,
so
they
get
reimbursed
well
because
there's
such
a
major
demand-
and
we
just
don't-
have
enough
slots
for
those
residents
to
be
trained.
So
it's
difficult,
I
think,
in
our
state.
The
last
time
I
checked
and
that's
probably
old
data,
probably
four
or
five
years
old.
We
had
59
child
psychiatrists
in
the
state
of
kentucky.
B
Half
of
those
are
cash
only,
and
so
I've
got
colleagues
that
I
train
with
at
uk,
who
I
go
to
see
them
and
say
why
don't
you
take
insurance?
It's
a
hassle.
I
don't
want
to
deal
with
the
insurance
headaches.
I
don't
want
to
deal
with
paperwork,
I'm
my
own,
my
own
employee,
the
only
employee
they
do
their
own
scheduling.
They
take
cash
per
hour
and
they're
up
to
their
ears
in
work
and
people
willing
to
pay
cash
to
be
seen.
B
B
It's
almost
third
world
country
deficiencies
that
we
have
there's
lots
of
factors
for
trying
to
get
people
to
get
into
the
world
of
psychiatry
and-
and
one
thing
we
may
want
to
consider
and
and
if
it's
okay
with
the
chair,
the
chairman,
the
chairwoman,
is
to
consider
dr
mccarron,
who
might
be
willing
to
do
a
zoom
call.
B
B
I'm
not
sure
if
they're
willing
to
do
business
with
us,
but
it
might
be
something
we're
preventing
at
least
to
get
information
to
see
something
that
we
could
do
here
to
look
and
try
and
at
least
get
our
primary
care
dogs
who
sometimes
just
don't,
have
the
skills
or
frightened
to
have
those
skills,
because
they're
scared
of
the
liability
that
goes
along
with
it,
but
be
able
to
provide
some
of
that
care
for
people
in
those
areas
and
dr
schuster,
I
just
wanted
as
long
as
I've
got
the
microphone.
B
Mr
chairman,
if
you'll
indulge
me,
you
know
a
lot
of
our
quantified
mental
health
professionals,
I
mean
I
do
a
lot
of
casey's
law
evaluations.
A
lot
of
I
haven't
done
so
many
as
far
as
tim's
law
issues
in
long-term
care,
we're
encountering
more
and
more
people
with
mental
illness.
Some
of
it's
homelessness,
people
that
are
treated
in
a
hospital
homeless.
They
get
treated,
they
come
to
us
for
rehab
and
then
their
fear
is.
Where
are
you
going
to
say?
I
have
nowhere
to
go
because
I
look
at
them.
B
They
look
pretty
functional
and
I
say
why
are
you
in
a
nursing
home
or
in
a
skilled,
nursing
setting,
I'm
homeless?
I
have
nowhere
else
to
go
and
it's
a
struggle
trying
to
find
you
know
kind
of
a
home
situation
for
them.
People
with
substance
use
is,
can
we
call
it
transitional
housing,
there's
different
terms
that
we're
using
for
that?
We've
got
to
find
some
kind
of
a
solution
for
that
and
really
again
the
mtmd
training
and
we
had
long-term
care
beds
at
eastern
state
and
passed.
B
I
know
we've
shut
a
lot
of
those
down.
We've
got
to
look
at
finding
ways
to
reopen
some
of
that
up.
It's
just
a
it's
just
really
an
access
issue
for
a
lot
of
it.
But
and
again
we
have
these
task
forces
a
lot
of
times
to
look
for
solutions
and
ideas,
and
so
we've
identified
a
lot
of
problems.
I
think
most
of
us
serve
on
health
and
welfare.
We
know
those
problems,
we
need
actionable
solutions
or
recommendations
from
you
all.
B
A
B
E
Thank
you,
mr
chairman,
and
dr
schuster.
That
was
just
a
fabulous
overview,
a
heartbreaking
overview,
but
I
feel,
like
you,
really
gave
this
task
force
a
blueprint
for
the
issues
that
we'll
be
looking
at
over
the
the
course
of
the
interim
and
I'm
on
the
housing.
The
houselessness
issue
and
dr
alvarado
brought
that
up
as
well.
E
It's
so
profound,
I
heard
a
statistic:
I've
been
talking
a
lot
with
folks
who
serve
houseless
people.
My
district
is
so
that's
such
a
huge
issue
right
now
and
with
the
unemployment
crisis,
it
has
been
it's
a
growing
issue
and
you
mentioned
that
two
to
four
percent
of
the
population
has
what
we,
you
know
severe
mental
illness,
and
I
heard
a
statistic
yesterday
that,
among
in
jefferson
county
among
the
houseless
folks
that
population
of
smi
people
is
more
like
50
to
60
percent,
and
so
I'm
I'm
curious.
E
If
you
know-
and
I
see
steve,
I
see
you
nodding
and
if,
if
we
have
hard
data
on
that
and
how
critical
that
supported,
housing
is
and
people
don't
necessarily
need
to
be
in
institutions,
but
they
need
a
roof
and
they
need
the
supports
and
they
need
access
to
meds
and
social
services.
And
you
know
yeah.
All
of
that.
H
That
does
not
surprise
me.
I'm
sure
that
adrian
bush
at
the
homeless
and
housing
coalition
of
kentucky
natalie
harris
at
the
louisville
homeless
coalition,
I'm
sure
wellspring
who
does
the
supported
housing,
would
have
those
statistics,
I'm
guessing
that
that
number
also
includes
people
with
substance
use
disorders
as
well.
H
I
mean
there's,
there's
co-occurring
issues,
obviously
with
mental
health
and
substance
use
disorders
and
sometimes
we're
not
sure
which
came
first,
the
chicken
or
the
egg,
whether
people
have
the
symptoms
of
anxiety
and
depression
and
so
forth
and
self-medicate
with
drugs
or
alcohol
or
whatever,
or
vice
versa.
But
my
guess
is
it
includes,
and
maybe
not
maybe
this
the
stat
that
they're
saying
is
they're,
looking
primarily
at
people
with
severe
mental
illness.
That.
C
E
E
H
H
A
Three
more
questions,
representative
flemming.
D
Thank
you,
mr
chairman
hi,
dr.
I
appreciate
your
very
good
explanation.
Everything
and
I'd
want
to
ask
you.
You
went
over
a
lot
of
information
and
probably
being
the
least
experienced
person
on
this
task
force
from
a
medical
standpoint.
Is
there
I
mean?
Can
you
make
that
your
comments
available?
Yes,.
D
D
Given
the
past
years
of
efforts
and
two
areas,
I
think
you
went
over
and
talked
about,
is
policy
and
funding,
and
so
I'd
like
to
I
like
to
think
that
over
the
next
several
months,
we
can
come
up
with
a
priority
list
that
we
can
try
to
really
move
the
need
at
least
five
to
six
ticks
on
the
on
the
meter.
Would.
D
To
get
get
that
going,
but
it's
going
to
take
a
lot
of
political
will
to
get
that
going
given
it's
a
small
segment,
but
it's
important
segment
in
that
because,
as
you've
articulated,
there
are
families
that
you
know
you
know
really
had
a
difficult
time,
particularly
the
tim's
law
and
the
family
that
went
through
that
process.
D
So
I've
got
a
couple
questions,
mr
chairman,
I'll,
try
to
be
ask
these
quickly
and
hopefully
get
a
quick
response,
as
the
senator
alvarado
mentioned.
If
we
can
go
through
and
prioritize
exactly
with
the
biggest
hits
that
we
can
do
in
moving
that
needle,
that
would
be
greatly
appreciated,
but
data
is
going
to
be
it's
going
to
be
important
and
if
we
can
have
the
data
that
will
substantiate
funding
and
policy,
it
makes
it
easier
so
for
this
task
force
to
go
through
and
convince
our
colleagues
to
go
through
that
process.
D
So
that's
one
thing:
the
other
thing
is
you
mentioned
about
the
psychiatrist
and
I've.
I've
run
a
very,
very
small
mental
health
center.
We're
non-profit
and
we
have
our
psychiatrist,
is
retiring
and
we're
in
a
pickle
in
terms
of
who
do
we
refer
to
when
it
comes
to
mid
management.
D
And
if
dr
wilder
has
some
suggestions,
I
would
appreciate
it
but
yeah,
but
there
are
there's,
there's
two
things
I
guess
pertaining
to
that
one.
What
is
it
what's
the
barriers-
and
I
think
I
know
the
answers-
what's
the
beers
to
try
to
get
better
reimbursements
for
these
professionals
in
order
to
attract
more
individuals
into
the
field,
not
only
from
md
point
of
view,
but
also
from
an
np
point
of
view
in
doing
that,
because
we
try
to
go
through
the
process
to
have
somebody
come
on
board.
D
It
was
going
great,
but
the
logistics
was
difficult
and
they're
coming
to
ellensboro
and
we're
just
out
in
left
field.
So
what's
the
number
of
psychiatric
nps
and
what's
the
possibility
of
tap
into
that
two?
What's
the
the
barriers
that
we
can
try
to
move
the
mcos
to
be
a
little
more
receptive
and
open
to
change
these
dynamics,
so
we
can
make
it
easier.
H
I
don't
have
the
number
of
psychiatric
mental
health
np's
right
at
the
at
my
fingertips.
I
I
will
make
my
comments.
H
Avail
available,
along
with
a
resource
list,
a
reference
list
of
stats
and
links
to
the
legislation
itself
and
those
kinds
of
things,
and
I
promise
you
we'll
have
that
before
your
next
task
force
meeting
how's
that
I
think
that
you
know
so
many
of
these
folks
are
taken
care
of
on
medicaid,
so
we
really
need
to
focus
on
the
reimbursement
under
medicaid
and
nps
are
paid
75
of
what
physicians
are
paid
for
the
same
service.
H
So
you
have
a
step
down
to
start
with
for
the
for
the
mps,
and
my
guess
is,
as
senator
alvarado
pointed
out-
and
I
was
going
to
say
this
earlier-
you
know
most
of
the
psychiatrists.
I
know
do
what
I
call
a
boutique
practice.
They
literally
do
cash
only
I
mean
they
do
not
take
insurance
of
any
kind,
much
less
medicaid,
which
is
the
lowest
paying
of
any
of
them.
So
to
to
get
that
up.
H
I
mean
I'd
love
to
see
a
differential
somehow
for
psychiatry,
because
it's
you
know
we
have
so
few
numbers
and
we
have
such
a
great
need
in
that
area
and
whether
there's
something
that
medicaid
could
do.
H
H
There
were
so
many
pieces
that
I
wanted
to
tell
you
about.
I
wanted
you
all
to
drink
from
the
fire
hose
at
the
same
time,
and
some
of
you
are
at
very
different
places
than
others
in
terms
of
knowing
this
population
and
so
forth.
I
was
trying
to
get
the
most
important
things
there
and
I
talked
way
over
my
time,
but
I
you
know
so
I
my
notes
are
a
little
bit
more
organized
than
maybe
my
presentation
was,
but
I
will
get
it
to
you.
D
Yeah
I
appreciate
that
and
you're
right
there's
a
lot
of
different
facets
and
and
it's
drinking
drinking
out
of
a
fire
hose.
We
we
understand
that,
but
but
it
is
also
important
that
we
narrow
this
focus
down,
because
we
as
legislators,
we
have
narrow
bandwidths,
given
that
we
have
so
much
going
on
well.
D
It
is
true,
but
you
know
I
mean
I
tell
I
tell
when
I
was
coaching
lacrosse.
I
told
my
girls,
it's
like
you
know
the
longest
distance
you
can
travel
is
mere
18
inches
and
they
sit
there
and
raise
their
eyebrows
and
their
heads.
What
do
you
mean?
D
So
it's
a
distance
between
your
head
and
your
heart
and
you're
trying
to
combine
those
two
and
doing
that,
and
so,
if
we
can,
if
we
can
combine
the
mental
aspect
of
people's
lives,
which
has
a
significant
impact
on
how
we
conduct
ourselves
and
how
we
live
our
lives
and
so
forth,
and
not
only
help
provide
support
and
funding
for
the
individual
who
suffers
that.
But
I
think
it's
more
important
from
a
holistic
point
of
view.
D
D
G
You
thank
you
so,
first
of
all,
I
want
to
say
thank
you
very
much.
Second
of
all,
I
just
want
to
make
sure
people
on
the
committee
understand
that,
from
a
a
mental
health
care
perspective
that
that
problems
with
access
to
care
are
not
only
limited
to
people
without
resources,
I
mean
at
this
point.
We
have
a
tremendous
problem
with
access
to
good
quality
mental
health
care,
even
for
people
who
are
fully
insured.
G
I
personally
had
an
experience
with
a
child
discharged
from
a
hospital
with
two
weeks
of
medication
with
instructions
a
phone
number
to
reach
out
to
a
psychiatrist
for
a
refill.
The
psychiatrist
not
only
couldn't
see
him
for
four
months,
but
was
completely
self-pay.
I
have
yet
to
find
a
good
psychiatric
health
care
provider.
When
my
child
goes
to
school,
that
is
anything
other
than
self
pay.
It
is
completely
out
of
network.
G
They
have
no
they're
too
busy
they're
too
overwhelmed
to
even
think
about
filing
insurance
for
their
patients.
Then,
when
you
do
file
on
your
own,
you
meet
barrier
after
barrier
after
barrier.
I
personally
spent
three
hours
yesterday
and
three
hours
again
today
with
health
care
companies,
insurance
companies
trying
to
get
reimbursed
from
mental
health
care
that
I've
paid
for
out
of
pocket.
It
is
and
I'm
privileged,
I
have
computers,
I
have
phones,
it
is
impossible.
G
The
system
is
broken
from
beginning
to
end
and
it
is
impacting
the
people,
the
least
resources
the
worst,
but
it
is
impacting
everybody
in
this
state
and
everybody
in
this
country
and
the
real
barrier
is
that
mental
health
care
is
treated
and
reimbursed
differently
than
any
other
type
of
health
care.
And
it
is
you
just
can't
get
them
to
cover
it.
You
can't
get
them
to
cover
it
and
for
a
reasonable
amount.
G
G
If,
as
a
state
honestly,
we
might
not
be
able
to
save
ourselves
money
over
the
long
run
by
actually
treating
these
people
treating
these
people
effectively
having
good
housing,
good
health
providers,
access
to
medication
and
not
having
to
pay
for
them
to
be
incarcerated
and
what
that
costs
are
not
having
to
deal
with
the
other
health
care
issues
and
the
the
societal
issues
that
come
with
these,
these
patients
being
homeless
or
houseless.
So
so
those.
H
Are
some
notices
research
results
from
the
cost
of
providing
a
year's
care
to
someone
with
severe
mental
illness
as
opposed
to
the
cost
of
incarcerating
them?
So
we
can
get
you
that
information.
E
G
E
Thank
you,
mr
chairman,
and
thank
you,
dr
schuster.
I
took
copious
notes
so
I'll
look
forward
to
see
my
notes
match
what
you
what
you
said,
but
you
said
a
lot
of
good
things
that
have
happened.
You've
said
some
things
that
weren't
so
good.
If
you
could
summarize,
I
mean
not
necessarily
right
now
verbally,
but
maybe
a
bullet
point
list
of
what
we
put
into
effect
or
what
has
been
put
in
effect
that
works,
that
we
need
to
continue
doing.
E
That's
a
great
idea,
and
I
do
and
a
list
of
things
that
you
think
need
to
be
changed
to
target
that
I
heard
echo
what
I'm
hearing
in
my
district
from
my
jailer
from
someone
who's
trying
to
provide
a
behavioral
mental
health
clinic
she's,
putting
it
together,
issues
that
she's
having
from
family
members
who
the
mental
health
can't
communicate
with
the
jail
or
the
family.
I
mean
so
we
may
hear
from
some
of
those
folks
later,
hopefully
a
couple
of
quick
questions.
E
Hopefully
you
talked
about
the
the
form
single
formulary
are
all
the
medications
going
to
be
on
there
that
are
needed
and
then
the
second
question
is,
it
just
seems
like
we
always
go
from
one
extreme
to
the
other.
You
know
we
de-institutionalize
and
then
you
have
the
homeless
where's
the
happy
medium.
Do
you
have
any
suggestions
for
happy
medium
like
I
like
your
idea
about
the
115
waiver
for
housing?
E
Could
there
be
some
sort
of
assisted
living
that
medicaid
are
reimbursed
for
for
mental
health,
where
they
could
be
monitored
for
meds?
And
things
like
that?
I
don't
know
I'm
just
I'm
just
brainstorming
out
loud,
but
anyway.
H
No,
if
you
could
answer
those
things,
that's
a
great
idea.
Yes,
the
single
formulary
will
have
all
of
the
medications
that
are
that
are
needed
and
the
the
beauty
of
it
if
we
can
get
there
is
that
it
will
be
the
same
for
everybody
who's
on
medicaid,
whereas
now
it's
every
mco
has
a
different
list
and
so
forth
and
again
the
medicaid
pharmacy
department
and
the
medicaid
commissioners
and
deputy
commissioners
have
been
very
responsive
to
us.
H
We
have
a
very
active
behavioral
health
tech
and
they
are
there
and
we
have
our
psychiatrists
and
psychiatric
nurse
practitioners
and
the
providers
they're
saying
we're
still
having
this
problem.
You
know
you
need
to
fix
this
and
they
they
really
get
on
it.
So,
yes,
that's
that's
great.
I
think
that
I
think
the
medicaid
waiver
could
be
written
to
include
a
residential
option.
H
That's
not
supported
housing,
as
we
think
of
somebody
being
in
an
apartment
with
somebody
checking
in
with
them,
but
could
actually
be
a
residence,
a
three-person
residence,
for
instance,
with
a
house
mom
or
a
house
dad
or
something
like
that.
I
mean
there
are
variations
that
you
can
do
and
there's
a
fair
amount
of
flexibility
paying
for
it.
You
know.
H
Obviously,
we've
got
a
great
what
we
call
fmap
here,
so
we
put
up
30
cents
and
we
get
a
dollars
worth
of
services,
but
we
still
have
to
find
those
those
30
census
for
those
for
those
programs.
I
think
that
we're
spending
it
on
the
incarceration
side.
I
think
we're
spending
it
in
the
hospitalization
side.
I
mean,
I
think
those
are
where
you
do
the
cost
savings.
But
yes,
we
would
look
at
that.
So
you
know
I
think
that
happy
medium
is.
H
You
can't
tell
in
72
hours
with
these
folks
whether
that
medication
is
working
or
not
so
there's
something
going
on
in
terms
of
you
know:
are
the
hospitals
being
advised
not
to
keep
people
longer
than
72
hours?
I
don't
know,
but
I
think
it's
a
real
issue.
I
think
we
ought
to
look
at
it
because
if,
if
you're
going
to
have
them
in,
let's
keep
them
in
long
enough
to
make
sure
that
they're
absolutely
stabilized
and
you
have
time
to
do
a
discharge
plan
and
to
alert
the
family.
H
I
think
you
all
heard
from
my
friend
marcia
van
van
hook
about
the
sad
case
of
her
brother
who
you
know
died.
They
barely
got
him
into
eastern
state
hospital
and
the
next
thing
they
knew
they
were
letting
them
out
and
that
family
was
ill-equipped
to
deal
with
that.
So
I
think
you're
going
to
hear
that
from
family
members,
yeah.
I
Appreciate
the
dr
schuster's
presentations
always
they're
very
insightful
and
I'm
sorry,
I'm
just
a
little
bit
too
pragmatic
for
my
own
good.
You
know
much
of
this
boils
down
to
funding
for
the
services.
There's
no
doubt
about
that.
You
know
we
lose
sight
of
the
fact
that
this
is
the
richest
country
in
the
world
and
we
spend
two
three
times
more
than
other
industrialized
nations
on
on
medicine,
the
money's
there
we
know
it's
there
and
the
comments
I
would
have.
I
I
just
want
to
caution
the
committee
that
when
we
look
at
funding,
what
we're
really
talking
about
is
a
reallocation
of
resources
and
you've
already
touched
on
that.
I
see
this
so
much
in
state
government.
I
remember
we
had
a
conversation
two
years
ago,
co-chair
bentley
about
the
guardianship
program
and
they
said
we
need
200
more
social
workers.
If
we
do
that,
we
save
millions
of
dollars.
I
I
We
have
to
recognize
that
we're
trying
to
accomplish
two
things:
one
is
enhance
the
quality
of
life
for
everyone
that
we
serve,
but
also
reduce
the
cost
of
society.
For
for
these
issues,
it's
real
cost,
but
we
don't
identify
those
costs,
so
I
don't
think
we
need
really
to
raise
insurance
premiums
or
raise
taxes.
We
need
to
reallocate
those
resources,
but
with
that
we
have
to
have
a
good
baseline
of.
Where
are
we
spending
these
dollars?.
E
I
Already
mentioned
incarceration:
how
much
does
that
cost
is?
I
think
if
we
had
a
number
on
that
it
would
be
staggering.
So
the
obvious
answer
is:
why
aren't
we
reallocating
those
resources
over
to
this
issue?
Well,
part
of
it
is
folks,
don't
want
to
give
up
their
the
resources
they
have
and
we're
not
making
that
connection.
I
But
it's
a
leap
of
faith,
but
it
starts
with
having
a
vision
and
a
plan
for
the
future.
How
we
need
to
do
this
and
you've
touched
on
this
as
well.
We
don't
have
a
comprehensive
plan
for
this
and
we
need
a
comprehensive
plan
and
once
we
had
that
and
we
put
those
metrics
in
place,
I
think
this
becomes
a
whole
lot
easier,
and
I
know
this
is
being
very
simplistic
about
it.
I
I
In
fact,
dr
alvarado
had
a
conversation
with
one
of
the
mcos
earlier
today
that
talking
about
the
the
coped
vaccine,
payment,
100
bucks,
a
piece
I
guarantee
you're
going
to
come
out
ahead
when
you
do
that.
But
there's
there's
innovative
ways
to
do.
There's
different
ways
to
do
this,
but
we
can
do
it,
but
we
have
to
make
a
commitment
that
it
starts
with
the
redistribution
and
a
master
plan
of
how
to
do
it.
But
thank
you
for
presentation
and
thank
you,
mr
chair.
A
I
A
C
Well,
mine's,
pretty
quick
is
this
working
now
now
it
is
well.
My
name
is
mark
kelly.
I'm
an
lcsw
and
I've
worked
for
community
mental
health.
For
30
years,
I've
held
every
job
position
that
there
is
to
be
had
in
community
mental
health,
and
I
love
the
job
enjoy
the
population
and
you
really
have
to
enjoy
the
population
that
you
work
with
to
spend
30
years
with
them.
So,
but
I'm
going
to
talk
primarily
about
barriers
to
care
with
in
the
rural
areas
and
our
coverage
area.
C
Generally,
it's
it's
a
10
county
area.
It
starts
in
boyd,
county
and
ends
in
montgomery
county,
but
one
of
the
barriers
in
the
rural
areas
that
we
have
is
there's
again
chronic
shortages
of
mental
health
professionals
and
it's
so
bad
for
pathways.
My
agency,
we
are
providing
a
ten
thousand
dollar
incentive.
Sign-On
bonus
to
just
get
people
to
come
to
our
region
to
work.
C
Also.
We
have
been
doing
job
fairs
every
week
for
a
month
to
just
for
psychiatrists
nurse
practitioners,
lcsws
counselors,
anyone
with
a
billable
licensure
to
come
and
work
for
us
because
we
are
in.
We
have
terrible
work
shortage.
C
Nobody
wants
to
work
in
mental
health,
it's
a
tough
job
and
the
pay
is
not
great,
especially
in
community
mental
health,
as
you
can
imagine,
so.
The
other
barrier
is
acceptability.
The
pull
yourself
up
by
the
bootstraps
mentality
and
all
of
that
leads
into
stigma.
C
The
biggest
barrier
in
the
rural
areas
is
stigma,
and
all
of
these
are
going
to
dovetail
together,
but
you
live
in
a
small
area.
Everybody
knows
your
business.
Nobody
wants
to
come
to
community
mental
health
center.
I
had
helped
organized
a
nami
group
in
moorhead.
Kentucky
got
a
lot
of
commitment
from
the
community,
but
the
question
that
was
asked
over
and
over
was
was
there
a
back
way
in?
C
Could
they
come
in
the
back
way
and
we're
supposed
to
be
the
stigma
fighters,
but
they
were
too
embarrassed
to
come
in
at
pathways
where
we
were
having
the
meeting
which
boggles
mind,
and
we
have
so
many
families
that
are
suffering
with
that
have
loved
ones
who
are
going
to
the
hospital
over
and
over
and
in
the
rural
areas.
It
seems
like
that
the
resources
are
stretched
so
thin.
C
You
go
to
west
liberty,
let's
say
in
morgan,
county
and
there's
just
not
the
resources
there,
one
county
over
in
moorhead,
then
there's
not
the
resources
in
in
moorhead
a
couple
counties
over
in
montgomery
county,
because
montgomery
county
is
almost
like
lexington,
you
know,
but
the
further
east
you
go
the
more
difficult
it
is
now.
C
When
we
do
an
involuntary
hospitalization,
we
try
not
to
do
those
because
it's
taking
someone's
civil
rights,
we
don't
take
that
lightly.
We
don't
want
to
do
it
sometimes
you
have
to,
and
when
we
do,
that
you
know
that
involves
so
many
systems.
Besides
the
community
mental
health
system,
it
involves
the
county
attorney,
who's
got
to
get
the
petition
and
involves
a
petitioner.
C
It
involves
usually
an
emergency
room,
it
involves
the
sheriff's
department
and
it
involves
the
qmhp
from
the
community.
Mental
health
center,
like
those
are
five
different
systems
that
have
to
come
together
for
one
client
and
I'm
sorry
to
say
over
the
last
four
days,
we've
done
three
involuntary
commitments
a
night
and
that
involves
all
of
our
after
our
staff,
because
community
mental
health
centers
in
the
rural
areas
run.
C
C
C
C
Now,
I'm
still
a
practicing
clinician.
I
did
an
individual
with
a
lady
who
is
smi.
C
C
That
would
have
been
impossible,
so
kovid
did
help
the
rural
areas
in
the
fact
that
we
are
able
to
utilize
telemedicine
to
an
extent
to
where
we
we
used
to
have
a
lot
of
people
that
did
not
keep
appointments,
but
now
that
we
have
telemed,
we've
seen
those
rates
drop
and
people
keep
their
appointments
regularly.
C
We
haven't
seen
that
before.
So
that's
totally
new
and
we're
very
excited
about
that-
and
we
want
to
preserve
the
telemed
component
that
we
have
going
at
this
time
also
with
rural
areas,
that
that
means
that
there's
not
enough
bandwidth.
C
Some
people
come
in
if
they're
able
to
come
in
but
and
I'll
just
skip
down
here
to
transportation,
there's
no
transportation.
C
We
have
people
that
live
so
far
out
in
the
county
that
they
can't
get
into
us
even
if
they
wanted
to,
and
there
are
some
transportation
systems
that
are
there,
but
they
require
a
three-day
notification
beforehand.
C
So
you
know
it's
a
it's
kind
of
a
case-by-case
basis,
but
it
happens
over
and
over
and
over
with
clients
that
we
serve
and
on
the
handout
one
of
the
health
disparity
key
findings
from
the
appalachian
regional
health
commission.
C
I
know
that
dr
schuster
had
talked
about
targeted
case
management
and
target
case
management
really
is
the
hub
of
all
of
our
treatment
for
smi
individuals
and-
and
I
have
to
say
we're
required.
C
Now
I'm
the
keeper
of
that
contract
and
I
keep
all
of
our
admissions
and
discharges
and
there
are
quite
a
few
and
we
get
into
issues
with
managed
care
who
doesn't
understand
that
concept
that
we
are
required.
C
C
We
also
have
assertive
community
treatment,
which
is
a
team
approach
to
case
management
and
with
pathways
we
have
that
service,
primarily
in
boyd
and
greenup
counties,
and
you
know,
with
the
team
of
individuals
that
work
seven
days
a
week,
24
hours
a
day
with
a
group
of
individuals
usually
about
10
and
the
goal
is
to
help
them
live
independently.
C
Now
we
have
one
lady
who's
who
has
accepted
assertive
community
treatment,
and
she
has
gone
to
eastern
state
over
the
last
three
years.
31
times
she
has
no
family
and
she
has
several
physical,
complex
physical
health
issues,
and
that
team
is
very,
very
busy
with
just
that
one
case
to
help
her
stay
on
her
medicine
stay
on
her
heart
medication
stay
on
her
psychiatric
medications.
C
So
it's
a
daunting
task
and
it
takes
all
of
us
to
do
that
and
before
I
take
any
questions
I
just
want
to
say
there
is
we're
seeing
a
wave
of
providers,
stop
they've
stopped
accepting
medicaid
pathways
of
moorhead.
We
had.
We
have
a
dentist
office.
That's
next
to
our
mental
health
office.
We
had
got
our
smi
group
to
understand
the
importance
of
oral
health.
C
So
when
the
medicaid
rigs
open,
the
dentist
gladly
took
medicaid.
So
we
were
referring
all
these
people.
All
I
had
to
do
was
just
walk
across
the
parking
lot.
It
was
great,
but
he
called
me
last
week
and
said
we're
not
going
to
take
medicaid
anymore.
C
So
that's
going
to
stop
that
treatment
for
those
folks,
that's
accessible,
that's
in
walking
distance
for
them,
and
I
asked
him
why
he
said
the
administrative
burden
is
too
great.
It
takes
too
much
staff
to
get
pre-authorizations
to
keep
calling
to
you
know.
He
said
we
may
get
approval
for
a
cleaning
and
then
we
do
the
cleaning.
We
do
an
assessment
and
then
it
may
lead
to
a
root
canal,
and
then
we
can't
get
anybody
to
do
a
pre-off
for
the
you
know,
they
won't
give
us
approval.
C
So
it's
an
ongoing
issue
to
advocate
for
smi
folks
because
they
can't
do
it
themselves
so,
but
I
I
wanted
to
bring
that
up
as
well.
So
if
there's
any
questions,
senator.
A
G
Thank
you,
sir,
thank
you
very
much
for
being
here
and
for
caring
and
for
working
in
this
field
and
for
everything.
G
Thank
you,
everything
that
you
do,
and
I
just
I
just
have
have
one
question,
and
you
know
I'm
sure
this
data
is
not
readily
available,
but
if
we
could
find
it
I
mean
I
guess
my
real
question
is:
does
targeted
case
management
work
and
if
it
does,
can
we
show
its
cost
effectiveness
in
regards
to
you
know
decreasing
the
number
of
rehospitalizations,
a
decrease
in
the
number
of
arrests,
a
decrease
in
the
in
the
incidence
of
violence
or
a
decrease
in
the
incidence
of
homelessness.
G
G
C
Questions
right
and
and
having
worked
as
a
case
manager
and
trained
and
certified
case
managers
all
over
the
state.
I
believe
it's
a
vital
service
that
is
very
underrated
and
people
don't
seem
to
understand
it
very
well,
and
I
mean
I
understand
just
because
we're
required
to
provide.
It
doesn't
mean
that
that
makes
it
terrific,
but
you
know
it.
C
It
is
a
very
good
service
for
our
folks,
and
also
I
wanted
to
mention
you
know
our
after
hours
when
we
go
out
and
we
do
different
evaluations,
we
go
to
the
jail
more
to
do
evaluations
than
we
do
the
emergency
room.
Wow
I
mean
it's.
I
look
at
our
crisis
numbers
every
morning
to
see
where
we
went
the
night
before
and.
F
C
G
And
at
the
same
time,
if
I
could,
I
really
would
like
to
reiterate
not
just
to
the
people
in
the
community
but
to
all
around
the
committee.
All
of
us.
You
know
the
problem
of
dual
diagnosis
that
so
many
of
these
patients,
because
they're
underlying
mental
health
care
problems
are
not
being
treated,
also
become
a
part
of
the
problem
of
the
of
the
addiction
in
our
society,
and
that
you
can.
You
can
try
to
treat
one.
C
Well,
the
uptick
at
the
jails
is
because
we
have
a
group
of
clients
that
are
between
ages,
18
to
25,
primarily
male,
that
utilize
meth
become
psychotic,
looks
schizophrenic
and
we
get
called
in
and
evaluate
them
and
they
look
very
much
schizophrenic,
regardless
of
how
they
got
there.
We
have
to
go
with
what's
in
front
of
us,
and
so
we
end
up
doing
involuntary
commitment,
because
these
guys,
their
their
brains,
are
so
disrupted
that
they
really
can't
consent
to
care.
C
So
we
end
up
sending
them
to
eastern
state,
and
then
you
think
you
know
families
will
call
me
and
say
well
when
that
meth
wears
off
he's
gonna
be
okay
right,
no,
not
necessarily
like
they
can
sustain
brain
damage
and
it's
what
we
see
is
I've
had
some
of
that
age
group.
C
Well,
they
tested
positive
for
meth.
I
know
but
they've
got
you
know,
brain
problems
like
they're,
really
psychotic
and
out
of
control.
So
we
end
up.
You
know,
doing
due
diligence
and
send
them
appropriately,
but
that's
a
whole
new
phenomenon.
For
for
us,
is
these
newly
smi
males
that
have
utilized
meth
to
the
point
of
where
they've
induced
a
psychiatric.
A
Yeah
well,
I
got
two
more
questions:
okay
and
senator
alvarado
and
then
representative
fleming
and
then
we'll
take
your
yeah.
I
can
come
back
how
about?
I
want
you
to
come
back
some
cause.
I
know
you
got
a
lot
to
say.
B
Okay,
thank
you
so
as
you're
talking
about
telemedicine,
which
is
obviously
something
we've
been
working
on
really
hard
here
in
kentucky,
and
I
think
we've
got
a
really
good
telemedicine
bill.
The
one
we
passed
back
in
2018
was
with
the
purpose
of
using
letting
as
long
as
the
provider
is
licensed
in
the
state.
They
can
be
anywhere
in
the
country.
As
long
as
they've
got
a
license
for
kentucky,
they
can
practice.
So
it
prompted
me
to
look
it
up.
B
I
just
found
stats
for
kentucky's
total
psychiatric
psychiatrist,
350
active
practicing
psychiatrists
in
the
state,
that's
about
eight
psychiatrists
per
hundred
thousand
residents.
That's
what
we
have
as
far
as
overall
imagine
a
telepsychiatry
a
kind
of
website,
so
the
medicaid
reimbursement.
To
give
you
an
idea
when
I
was
practicing
in
my
own
clinic
when
we
took
in
what
we
were
receiving
from
medicaid
for
a
visit,
what
it
cost
us,
we
were
making
about
two
dollars
a
visit,
so
you
see
four
people
in
an
hour
you're,
making
eight
bucks
an
hour.
As
a
doctor.
B
Looks
saying
and
really
with
the
liability?
That's
added
if
you
make
one
wrong
diagnosis,
end
of
your
practice,
end
of
your
career,
potentially
all
those
kinds
of
things.
So
it
got
to
the
point
where
it
did
really
tough.
You
would
limit
how
many
you
would
take.
It
was
almost
a
public
service
to
your
community
to
take
on
those
folks
if
you're
willing
to
see
them,
but
so
many
providers
who
are
unwilling
and
that's
the
reason
why
you
start
looking
at
their
numbers,
they're
taking
a
loss
right
and
that's
we
were
really.
B
We
were
really
trim
with
our
numbers
and
our
finances
and
that's
a
lot
of
the
issues
that
we're
saying
I
went
on.
You
know.
I
used
com
care,
a
lot
in
clark,
county,
obviously
papa's
enemies
in
montgomery
they're,
both
in
my
district.
But
when
we
looked
at
comp
cure-
and
I
was
looking
here
at
job
postings
and
the
number
of
job
postings,
if
anybody
you
guys
want
to
take
a
look,
I
mean
it's
an
extraordinary
amount
of.
You
know
you
look
in
fayette
county,
look
at
floyd
county,
I
think
they've
got.
B
I
don't
know
30
positions
that
are
open,
that
they
can't
find
people
for
clearly
and
providers.
I'm
just
curious
in
terms
of
when
you
do
get
a
psychiatrist
locally,
how
long
they
stay
for
and
have
you
explored,
maybe
getting
a
psychiatrist?
That's
off-site,
I
mean,
I
know
it's
sometimes
tougher,
but
if
you
get
somebody
who
might
be
out
of
state
with
the
kentucky
license
now
to
say,
hey
be
the
person
that
can
provide
our
services.
Are
you
exploring
those
issues
for
psychiatrists
as
well.
C
We
are
exploring
those
issues
just
because
the
unique
nature
of
the
community
mental
health
center,
the
prescriber,
doesn't
have
to
do
all
of
the
heavy
lifting
like
there
is
liability
there,
but
if
you've
got
the
community
mental
health
center,
that's
doing
the
day-to-day
operations
with
that
patient,
then
you
know
the
the
burden
isn't
on
the
prescriber.
Always
so.
Yes,
we
we're
looking
at
that
option.
Our
only
concern
about
that
is,
you
know
it's
continuity
of
care.
We
want
to
keep
good
continuity
of
care
now.
B
B
G
B
C
Well
and
they're
young
and
at
the
age
of
onset,
but
I
I
do
a
lot
of
presentations
for
the
social
work
graduates
at
uk
and
at
morehead
state,
and
I'm
always
saying
who,
in
this
graduating
class,
is
coming
to
mental
health.
Nobody
who,
from
these
graduating
classes,
are
coming
to
eastern
kentucky.
I
C
Benefits-
and
you
know,
there's
more
of
a
culturally
diverse
area,
so
you
know
young
people
they're
they're,
not
staying
with
us
if
there
was
only
an
incentive
for
because
there's
a
huge
shortage
of
licensed
clinical
social
workers.
C
C
C
So
we
have
this
one
degree
that
is
medicare
billable
and
we
have
a
shortage
of
everybody,
but
we
have
a
huge
shortage
of
licensed
clinical
social
worker
because
they're
so
in
demand
in
the
urban
areas
and
in
other
you
know,
positions
that
we
cannot
bring
them
this
way.
That's
that's!
Why
we're
offering
a
ten
thousand
dollar
sign-on
bonus?
C
B
And
again
anything
again,
just
I
think
every
person
that
comes
to
present
we
welcome.
We
can
identify
problems,
we're
good
at
that
in
healthcare,
sometimes
saying
here's
the
issue,
here's
the
problem,
I
got
a
problem
here.
We
need
to
have
some
solutions
that
we
can
act
on
and
you
all
are
living
it
every
day,
so
anything
that
you
can
have
as
far
as
providing
us
recommended
reductions
of
barriers
to
provide
care
or
things
that
we
can
get
done
as
the
state
would
be
welcome.
So.
C
D
Thank
you
chairman.
I
was
trying
to
phrase
my
question
mark
because
I
can
go
come
from
quite
a
few
different
angles
and
I
want
to
bridge
off
with
senator
alvarado's
mentioning.
D
It
seems
to
me
that
part
of
the
barriers
are
the
boards
themselves
in
terms
of
going
through
requirements
and,
for
example,
your
profession.
We
needed
somebody
on
our
staff,
but
it's
gonna
be
a
year
before
this
person
can
come
on
because
they
come
from
illinois.
I
D
Can
also
go
into
reciprocal
agreements,
but
I
don't
know
if
you
want
to
go
down
the
recon
recognize
process
in
doing
that.
Do
you
feel
that
there
is
a
barrier
or
an
issue
or
a
problem
in
terms
of
bringing
people
on
that
are
out
of
state
into
this
in
the
state
to
be
licensed,
so
we
can
go
around
or
cut
at
least
cut
some
of
the
requirements
from
the
board.
Providing
you
know
things.
Things
are
done
in
an
approved
manner,
to
increase
accessibility
to
the
healthcare
providers.
C
Well
sure
I
mean
you
know,
there's
different
requirements.
Different
social
workers,
social
work
boards
in
different
states
require
different
things,
so
you
may
qualify
in
one
state
to
be
billable,
but
not
qualify
in
this
state
to
be
billable.
So
there's
got
to
be
a
unifying
of.
D
So
you
think
there
should
be
a
federal,
a
federal
law
or
something
like
that
to
do
that,
to
have
a
more
of
an
interstate
type
of
commerce.
D
The
other,
the
other
question
I
have,
mr
chairman,
if
you
don't
mind
asking
this
general
assembly
passed
300
million
dollars
in
terms
of
broadband
accessibility
to
to
those
underserved
areas
for
25,
I
guess
25,
megs,
download
and
three
upload
and
so
forth.
D
Part
that
is
going
to
get
into
those
those
harder
to
reach
areas.
What's
that
going
to
do
to
to
like
your
organization,
you
have
three
shops.
Is
that
right?
Three
three
store
three
stores:
sorry.
C
D
Okay,
I
saw
something
around
three
but
I'll,
probably
look
in
a
very
small
area.
Could
you
just
explain,
explain
how
that's
going
to
help
you
out
if
at
all,
and
if
that's,
if
that's,
if
that's
gonna,
be
enough
to
to
help
you
all
out
in
terms
of
getting
that
accessibility.
C
Well,
it
will
help
us
reach
the
unreachable.
Some
of
the
folks
that
you
know
like
in
ellicott
county,
like
you,
can't
even
get
a
satellite
signal.
C
D
There
is
a
program
that
they
can
have.
They
can
get
access
like
fifty
dollars
in
order
to
help
with
the
with
a
payment
on
a
monthly
basis,
also
there's
an
acquisition
program
as
well
to
help
out
to
give
those
individuals,
those
computers
and
those
that
accessibility.
There
is
a
program
out
there
to
help
through
that,
but
it's
not
publicized
a
lot
of
people
don't
know
about
it
right
and
I
get
it.
C
Right
yeah:
we
we
need
to
promote
that
because
you
know
these
are
the.
These
are
the
same
folks
that
are
not
going
to
get
the
covet
vaccine.
I
mean
yeah,
you
know,
like
they
they're
just
they're,
not
coming
to
the
health
department
to
get
information
they're
not
coming
to
the
mental
health
center
to
get
information
they're.
C
You
know
if
they're
involved
with
any
part
of
us
of
of
any
services,
it's
through
social
services
because
they've
it's
a
kid
issue,
but
you
know
those
folks,
I
mean
they
live
on
a
hilltop
and
you
know
if
it's.
If
it's
raining,
they
get
a
good
tv
signal.
That
day,
you
know
I
mean
that's.
A
I
could
tell
you
a
good
story
about
that:
okay,
stevie
say
you
come
back.
Yes,.
J
J
Thank
you,
his
testimony
that
I
provided
in
june
of
2019
at
the
invitation
of
chairman
alvarado,
and
that's
about
a
and
includes
an
smi
waiver
that
dr
schuster
talked
about.
That's
a
housing
answer:
it's
in
their
packet.
It's
in
there
four
pages,
my
testimony
from
that.
The
other
thing
I
want
to
talk
about
in
terms
of
a
plan.
J
J
J
Prescribed
drug
should
be
covered
for
ambulatory.
That
was
a
language
back
there,
as
well
as
hospital
patients.
Okay,
that
was
a
pattern
for
change
1966
that
was
done
june.
21St
2001..
This
is
a
template
for
change.
There
was
a
thing
called
the
843
commission
after
house
bill,
843
the
2000
session
right
sheila,
sponsored
by
representative
mary,
the
margin
and
a
variety
of
others.
J
J
transportation
access.
We
heard
that
from
mr
kelly
still
a
problem.
2001.
quality
assurance
got
the
right
outcomes:
housing
2001.
We
talked
about
housing,
included
collaborate
with
kentucky
housing,
corporation,
increased
state
funds
for
housing,
increased
direct
state
support
and
federal
match
money,
that's
a
way
to
say:
medicaid,
okay
for
housing
options,
including
independent
living
transitional
housing,
halfway
houses,
group
homes,
assisted
living
supervised
apartments,
2001.
J
had
a
piece
on
supported
employment.
We
talked
about,
then
people
having
a
job
and
a
good
place
to
live.
I
contend
that
is
not
a
particularly
high
standard
for
anyone
in
our
country
and
I
concur
with
senator
meredith.
We
are
the
richest
country
in
the
history
of
this
planet
and
we
can't
guarantee
people
who
are
severely
mentally
ill,
an
opportunity
to
work
and
a
decent,
safe
place
to
live.
It's
unacceptable
talked
about
criminal
justice.
We've
talked
about
this,
a
lot
I'm
getting
too
old
truthfully.
J
We
need
to
do
something
and
I'm
so
excited
this
exists
and
I'll
go
into
more
detail.
But
just
to
the
answer
we've
had
conversations.
We've
had
a
lot
of
discussions.
I
worked
for
a
gentleman
who
was
there
when
president
kennedy
signed
the
legislation
that
created
our
system.
He
was
there.
He
worked
on
it.
He
told
me
what
it
looks
like
he
told
me.
We
are
a
regional
model.
Representative
bentley.
We
are
a
regional
model.
We
have
an
obligation
to
our
communities,
we
have
an
obligation
gentleman's
dan
howard.
He
passed
away
last
fall
quickly,
dan
howard.
J
He
was
a
unique
individual
because
and
he
was
unique.
President
kennedy
handed
him
a
pen,
adolph
rupp
told
him,
don't
pass
behind
your
back
and
bear
brian
said.
If
you
break
your
ankle
again,
the
football
team
will
have
to
keep
it.
Those
are
all
true
stories:
football,
basketball,
uk
and
president
kennedy.
No
one
else,
that's
all
I
got
I'll
come
back.
I
have
more
information.
A
So
this
has
really
been
a
great
committee
me
not
you
know
we
don't
have
the
passion
after
all
that
something's
wrong,
but
before
we
adjourn
members,
please
note
that
remote
access
will
be
allowed
for
all
meetings
for
the
interim
members
will
be
provided
the
information
prior
to
the
meeting
on
how
to
access
the
meeting
remotely
and
the
meeting
materials
will
be
made
available
online
for
downloading
the
next
scheduled
meeting
date
available
is
july,
20th
at
3
p.m.