Flawed system for Kentucky’s mentally ill

Aug 11, 2021 | News

By James Line

An unusually large snowfall had blanketed the small Kentucky town of Scottsville. On the night of Feb. 25, any patients at Scottsville Manor, a personal care home, were likely indoors, their right to walk the streets whenever they wanted to notwithstanding. Gary Glueck was one of them. In his eighth month at Scottsville Manor, Glueck was 71 years old on that icy night in February. The next morning he was dead.

That night, Glueck was stabbed with a pen and coat hanger before being strangled with a lamp cord.

“This guy’s trying to kill me!” he screamed, according to the wrongful death lawsuit filed by his estate.

His cries went unanswered. His attacker paused the torture twice for a drink of water. By the time he was finished, Glueck was dead. The attacker walked down the hall to the nurse’s station, asked for some more water, and informed a nurse that he had murdered his roommate, according to the police investigation.

Gary Glueck was killed by a man with whom he was assigned to share a room. A self-described Satanist who had legally changed his name to The Reverend, the murderer had shown signs of violence before, threatening to kill members of his own family, according to police records.

“The Reverend should have never been living there,” said Bob Young, the attorney for Glueck’s estate, which is currently suing Scottsville Manor in Allen County Circuit Court for wrongful death.

But while Glueck’s murder was uniquely brutal, it reflected broader patterns of neglect, mismanagement, and shortsightedness that have undermined Kentucky’s mental health care system.

Kentucky lags behind

Mental health care in America is a flawed system, with high costs and limited resources putting access out of reach for many. But Kentucky often falls below even the most dismal national indicators. Community mental health centers in Kentucky remain critically underfunded, placing the state 46th out of 50 states in funding per patient. Personal care homes – residential centers for people who need assisted living without skilled care – are increasingly strained, often lacking the professional staff or specialized resources to treat people with severe conditions who end up in their wards. Many mentally ill people are imprisoned instead, pushing Kentucky’s prison-to-hospital ratio for mentally ill people to nearly three to one.

“Kentucky’s been pretty much behind everybody else,” said Deborah Weed, president of the Bowling Green affiliate of NAMI, the National Alliance on Mental Illness. “It’s been very slow to get things done.”

The problems facing Kentucky’s mental health care system interlock. Fewer state funds mean fewer resources for treating patients, which means patients without the means to afford costly treatments are more likely to be sent to personal care homes that are not intended to treat people with severe illness, or, if they are convicted of a crime, to prison. Others who fall between the cracks find themselves on the streets, homeless. Those seeking a solution often find themselves at odds, too, as any attempt to balance competing interests between those who want safer streets, greater funding, autonomy for patients, and tighter budgets proves exceptionally difficult.

The story of how Kentucky got to this point dates back over a century. Mirroring trends in the rest of the United States, Kentucky started institutionalizing mental health patients around the turn of the twentieth century. In what was then considered a modern system, people were essentially warehoused in mammoth asylums, where doctors and nurses provided treatment and, perhaps more importantly to everyone else, patients were walled off from the general public.

However, over the years, the weaknesses of the institution system became too much for the public – and policymakers – to ignore. The asylums became woefully overcrowded and filthy, and exposés and government investigations shut most of them down by the 1960s. The new trend was community-based treatment, with patients living and working in their own communities, anchored together by a network of community mental health centers.

In 1966, Kentucky started to implement the Community Mental Health Act, a national law signed several years before by John F. Kennedy. The law established a constellation of public and non-profit community mental health centers that currently form the backbone of mental health care in America. Today, one out of 25 Kentuckians receives treatments from these centers, according to a report from the Kentucky Center for Economic Policy.

Treatment at community mental health centers includes both inpatient care (the patient lives in the facility for a certain period of time) and outpatient care (the patient lives at home), emergency services, and other forms of therapy and consultation, according to the National Council for Behavioral Health. Patients who don’t pay out of pocket are often funded via federal, state, or local mental health programs; Medicare or Medicaid; or private insurance.

But the community-based system established to replace the colossal asylums wasn’t built to withstand repeated slashes or slowdowns in public funding. In Kentucky, that’s exactly what happened.

“The diminishing amount of resources is a big factor,” said Brandon Render, former chair of the Homeless and Housing Coalition of South-Central Kentucky, about the lack of access to mental health care. “For example, in a city the size of Bowling Green, I believe there aren’t enough clinics and mental health care providers to support everyone in the community suffering from mental illness.”

In 2001, a state commission recommended that funding for mental health centers be increased by $25 million annually for the next 10 years to put Kentucky on par with the national average for state mental health funding, but the plan was never enacted.

Instead, the Kentucky state government has cut funding for mental health care year after year since 2013, according to NAMI data. And funding for community mental health centers from the Kentucky Department of Behavioral Health – a major source – hasn’t increased in 14 years, according to the Kentucky Center for Economic Policy.

Weed said she believes that on a fundamental level, prejudiced views about mental illness have a direct impact on how it is treated as a matter of public policy.

“Mental illness has always been kind of a ‘put it in the closet, no one wants to talk about it’ stigmatized kind of thing,” Weed said. “And so you have to stop that and get that to a point where people can get the help they need and not be ashamed to do that.”

Personal care homes fill gaps

For people with mental illness whose family cannot care for them, or who lack the financial resources to live on their own or afford necessary treatment, personal care homes are often the only option. Personal care homes are residential facilities designed for people who need assistance but do not require extensive treatment, and they differ from nursing homes.

“Personal care homes do not offer skilled nursing care and the patients staying there have to be able to care for themselves,” said Bob Young, an attorney at English Lucas Priest & Owsley LLP, a law firm in Bowling Green. “Nursing homes require skilled nursing care.”

In 2012, Kentucky Protection and Advocacy, a publicly-funded mental health non-profit, published a report that surveyed 218 residents in 20 personal care homes in Kentucky. The report found that 86 percent of surveyed residents were mentally ill and 10 percent had an intellectual or developmental disability.

Personal care homes were initially intended to serve people from local communities who, for whatever reason, were incapable of living on their own but did not require skilled care. But since deinstitutionalization, personal care homes now serve as centers of gravity for people with mental illness, pulling in residents from much wider regions than they had ever served before and creating a detour around the community mental health centers set up in the 1960s.

Most mentally ill people in personal care homes are referred to them either by their families or the state guardianship program, Young said. Under the Kentucky Cabinet of Health and Family Services, the Division of Guardianship can assign a social worker to a ward of the state, meaning someone “who has been declared legally disabled by the court and is no longer able to care for his or her personal and/or financial needs,” according to the state program’s website. One of those wards was Gary Glueck.

Young  has extensive experience in personal care home and nursing home litigation, and is currently representing Doug Hagan, a friend of Gary Glueck and to whom Glueck left his estate, in a wrongful lawsuit filed against Scottsville Manor. The lawsuit, which is ongoing, alleges that the personal care home failed to protect Glueck from his roommate even though it was well-known that The Reverend was aggressive.

“As a result of Scottsville Manor’s negligent, grossly negligent, wanton, malicious, or reckless conduct, Gary Glueck suffered unnecessary loss of personal dignity and personal injuries, including excruciating pain and suffering, mental anguish, and emotional distress,” the lawsuit states.

“Modern-day asylums”

In its 2012 report on personal care homes, Kentucky Protection and Advocacy claimed that personal care homes violate the Americans with Disabilities Act, which guarantees equal protection for people with disabilities, and Olmstead v. L.C., a 1999 case in which the U.S. Supreme Court determined that unjustified segregation of disabled people constituted a violation of the Americans with Disabilities Act.

The report described a situation in which residents were frequently subjected to demeaning treatment and unhealthy living conditions. The report also said that personal care homes function essentially as modern-day asylums, cutting off residents from the outside world.

“Personal care homes fail to integrate persons with disabilities into the social mainstream, fail to promote equality of opportunity, and fail to maximize individual choice,” the report said. “They restrict community and integration and interactions with individuals who do not have a disability.”

In Young’s view, the risks of ill-equipped personal care homes threaten the rights and safety of not only community members and staff, but also of the residents themselves, who he believes deserve a home that is as safe as possible. He said he believes more needs to be done to sort people with mental illness into homes that are capable of properly caring for them.

“As I read the statutes, there are no good guidelines to determine whether certain patients should be placed in personal care homes or nursing homes, or even whether they should be hospitalized or not,” Young said.

As people with mental illness and their loved ones grapple with the human cost of ill-equipped personal care homes, some government officials have attempted to resolve the problem on the state level.

In 2012, State Rep. Terry Mills, a Democrat, and State Sen. Jimmy Higdon, a Republican, introduced legislation in response to the death of Larry Lee, a 32-year-old resident of Falmouth Nursing Home – classified by state officials as a personal care home – who went missing in August 2011 and was found dead on the banks of the Licking River four weeks later. His cause of death was not determined.

Nicknamed “Larry’s Law,” the bill would have required potential residents to be examined by a mental health professional prior to admission to a personal care home.

“This is the only thing that we found that could have saved Larry Lee,” Higdon said in a 2012 interview with the Lexington Herald-Leader. “His condition was too severe. He should have never been in a personal care home.”

“Larry’s Law” passed and was signed by Gov. Steve Beshear. But although personal care home residents are now required to have been assessed before admission, Young believes that the assessments do not adequately measure the extent of some disabilities.

“Their evaluations are often based on factors such as whether or not the person is ambulatory,” Young said, referring to whether or not a person can physically move around.

Another murder

Just two months before Glueck’s murder, a resident of another Scottsville personal care home was also found dead. Stuart Hearell lived at Cornerstone Manor, and, according to the Allen County Attorney’s Office, had been reported missing five or more times in 2015 and was often seen walking along the highway, even venturing into Tennessee.

In November, Hearell went missing for the last time. On Christmas Eve, a former Cornerstone resident named Tommy Mulhall reported to police that he had murdered Hearell and took them to the shallow grave where he had buried his body.

With two murders involving personal care home residents in a matter of months, Allen County Attorney Cynthia Hagenbuch, whose jurisdiction includes Scottsville, said the personal care home issue has been a major focus of her office.

Hearell, the Cornerstone Manor resident who was eventually murdered, became known to local authorities after he frequently went missing for days on end. Hagenbuch said she pleaded twice with Hearell’s state guardian for him to be relocated, to no avail.

“I said, ‘He’s going to end up hurting himself or others, or getting hurt,’” Hagenbuch said.

After the murder of Glueck, Hagenbuch wrote a letter to the enforcement branch of Western State Hospital, a state institution, claiming Cornerstone Manor and Scottsville Manor did not have the capacity to take adequate care of their residents.

“For obvious reasons, the community as a whole is fearful that individuals having psychiatric and/or severe mental disabilities are being housed in their neighborhoods and freely roam unsupervised throughout their town,” Hagenbuch said in the complaint. “More disturbing, some of these individuals ride the edge of criminal culpability that limits our ability to hold them accountable. The personal care homes have exceeded their ability to care for these individuals and in doing so have placed the community at risk.”

In April 2016, two months after Glueck’s death, a troubled community met at the Allen County Public Library to discuss how something like this could be prevented in the future. The meeting featured state and local officials, mental health advocates and professionals, and law enforcement officers. Some present expressed concern over what they viewed as the stereotyping of people with mental illness as overly violent.

“Equating mental illness and violence is a slippery slope I’d like to avoid at all costs,” said Jeff Edwards, director of Kentucky Protection and Advocacy, at the meeting.

Meanwhile, Cornerstone Manor owner Jamie Vaught defended the practices of Scottsville Manor and Cornerstone Manor during the conversation.

“Our population here is common to personal care homes that exist across the state,” Vaught said.

But Hagenbuch believes that refusing to discuss the capacity of personal care homes to handle potentially violent residents increases the risk of harm to residents themselves. She said she considered some of the comments made at the meeting an attempt to shame public officials into backing off.

“The meeting was a waste of time,” Hagenbuch said.

Hagenbuch said she believes that the problem ultimately lies with the state guardianship program, which she says shuttles people under their care into personal care homes because the cost is cheaper than that of psychiatric institutions, which today house only patients with severe illnesses. She also said that personal care homes often have no real choice but to admit them as residents because of their financial reliance on receiving admissions from the state. If the state decided to pull its flow of residents from a certain personal care home, it might sink the home itself.

“They’re essentially psychiatric institutes now,” Hagenbuch said.

Homelessness and incarceration

Underfunded community health centers and overburdened personal care homes aren’t the only challenges facing people with mental illness in Kentucky. The state also has high rates of homelessness and incarceration for the mentally ill population.

Render, former chair of the Homeless and Housing Coalition of South-Central Kentucky, said that in his experience, he has seen that budget cuts to mental health services and the resulting lack of access have a direct impact on both crime rates and homelessness rates for mentally ill people.

“It’s really difficult for people with a severe mental illness to find and maintain employment,” Render said. “Since mental illness is something that people have to deal with every day, it makes it difficult to stick to a routine or handle multiple responsibilities simultaneously — which is often necessary for stable employment.”

Render said that the lack of jobs for people with severe mental illness makes those individuals more likely to end up on the streets or in jail.

According to a state report conducted in 2009, 31 percent of homeless people in Kentucky – nearly three in one – are severely mentally ill.

“Most people who suffer from illnesses like schizophrenia live with a relative, which is often a parent,” Render said. “When those relatives pass away, they have trouble living on their own for many reasons – a lack of financial resources, the inability to case for themselves, criminal or rental backgrounds, etc.”

People with mental illness also face significantly higher rates of incarceration than the general population, and Kentucky prisons are often not equipped to properly treat them. As the old mental institutions faded away, prisons and jails became the default option when state governments failed to fully fund community mental health centers.

“Prisons and jails have become America’s ‘new asylums,’” according to a report from the Treatment Advocacy Center, a national organization that advocates for mental health care reform.

According to data compiled by the Treatment Advocacy Center in 2010, Kentucky has imprisoned over 4,800 people with severe mental illness, compared to the approximately 1,600 people with severe mental illness who are hospitalized. This places the likelihood of incarceration to hospitalization for mentally ill Kentuckians at nearly three to one.

Kentucky is not unique in its disproportionate incarceration of mentally ill people, according to national data. But Render said that Kentucky’s unusually deep funding shortfalls for mental health care have a special impact.

“Not only is access to treatment difficult, but connections to other programs are hard to come by as well,” Render said.

Weed, from Bowling Green NAMI, said another contributor to the problem is that people with severe mental illnesses often don’t realize that they’re ill and need help.

“They see it as something they been told they have, but they don’t think they’re ill,” she said. “Why take medication if you’re not ill? And then the next thing you know, if you’re in jail for 30 days and you have Medicaid, they drop it. So, now your medication isn’t paid for and the jail’s responsible for that.”

Once people with severe conditions are in jail, the lack of appropriate treatment there often makes matters worse, Weed said.

“They can be hearing voices; they can be seeing things that are very real to them,” she said. “And maybe the jail will get [the medication] on time and maybe they won’t get it for a couple of days. Then they act out, and they get to go to solitary confinement, and the whole time, you and I and everybody else is paying for that with our taxes.”

Outpatient treatment

In 2016, House Bill 94 – known as “Tim’s Law” became law after the General Assembly overrode a veto by Gov. Matt Bevin. The law was named after Tim Morton, who had schizophrenia, and according to the Lexington Herald-Leader, frequently wandered around downtown Lexington. He died at the age of 56 from long-neglected medical ailments.

The law requires the establishment of “assisted outpatient treatment” as a means of providing treatment for some people with mental illness, meaning that a judge could order people who may be unaware that they are ill to receive outpatient treatment, with a social worker and public defender assigned to provide assistance.

According to a study of the effects of a similar law in New York, people who undergo assisted outpatient treatment are far likelier to steer clear of hospitals, jails, and the streets than they were before participating, with 74 percent fewer experiencing homelessness, 77 percent fewer experiencing institutionalization, and 87 percent fewer experiencing incarceration.

The bill passed the General Assembly and was vetoed by Bevin, who described the bill in his veto message as “a dangerous precedent that would threaten the liberty of Kentucky’s citizens.” But in an unusual move, both houses of the General Assembly voted nearly unanimously to overturn the veto, to the raucous applause of activists packed into the marble halls of the Capitol.

“That gives me goosebumps because it’s like, ‘They’re getting it. They’re finally getting it,’” Weed said.

As the state government inches forward, much of the work being done to take care of people with mental illness is being done by volunteers in programs such as NAMI.

Bowling Green has had a NAMI affiliate for over 30 years, said Deborah Weed, who oversees the local affiliate. Four years ago, LifeSkills, a local community mental health center, received a state grant that it offered to Bowling Green NAMI. In turn, NAMI used it to open Wellness Connection, a small building which provides a space for community support efforts.

Events at Wellness Connection include seminars to teach people with mental illness – as well as their friends and families – about how they can live full lives with their conditions. Many of these classes are taught by people with mental illness themselves, who use their lived experiences to provide helpful information to others with the same disabilities.

Weed cited a recent example of a man with schizophrenia who experiences auditory and visual hallucinations. He teaches a class on schizophrenia, combining his lived experience with textbook information on the illness.

“We try to encourage that, because people who have a mental illness and who have gone through being told, ‘You have a mental illness. Life is over,’ need to have some encouragement and things, so as they get stronger, we ask them, ‘What would think about teaching a class on that?’” Weed said.

Other people with mental illness create art, meditate, and socialize at the Wellness Connection. Funding from the center comes from private donations as well as a variety of grants.

Weed said she is grateful for the state’s support of Wellness Connection, especially in light of Kentucky’s relative lack of funding for mental health care.

“I’m actually really proud of the support we’ve gotten from the state,” Weed said.

Wellness Connection

Wellness Connection, the small building used by Bowling Green NAMI, is nestled between a rusty auto repair shop and a skate park.

On a spring Friday afternoon, the scene at Wellness Connection is soft and peaceful, a far cry from the icy night in Scottsville two years ago that epitomized the nadir of mental health care in Kentucky.

Weed and another NAMI volunteer are in the back, working with a client in a confidential meeting. The walls of the office are dotted with posters and flyers about various counseling services. Statewide NAMI awards rest between those. Faint murmurs come from down the hallway.

“I’m so proud of the progress you’ve made,” one of them says to the person they are counseling.

Later, when the elderly client leaves for the day, Weed sits down to eat a small lunch between activities with her fellow volunteer, a friend of hers. She feels a sense of hope about the future and the role groups like hers can play in creating a mental health care system that doesn’t allow people to fall through the cracks.

“That’s why we have this center,” she said. “To tell people, ‘They’re gonna wear you out. You’re gonna have to keep calling, keep fighting, to get these things taken care of.”

As flowers blossom outside in the warming weather, Weed and her friend finish up their lunches and get back to work.

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