Mental Health Treatment in Kentucky

Mental health has long been overlooked as a crucial factor in overall health and well-being. However, recently mental health has recently taken center stage in public health discussions across the nation. Like every state, the state of Kentucky faces a unique set of challenges regarding mental health and mental illness ranging from substance abuse problems to suicide to depression & anxiety. Of the major concerns that arise with these varying mental health concerns, one that is often ignored is the victims’ access to the appropriate healthcare. Most Americans, approximately 164 million have insurance plans via their employers. Despite that, in many states including Kentucky, insurers can set their own standards regarding what they deem as a medical necessity. Often instances occur where an insurance company interposes itself between the mental healthcare provider and the client sometimes threatening the provider’s job security, often assaulting their dignity, as well as sifting through case notes with sensitive details. Social workers, healthcare providers, therapists, psychologists, etc., commonly deal with these ethical dilemmas which often leaves them in a situation where they wish to act morally but cannot given the constraints of their predicament. In some instances, this leads to our most vulnerable communities being denied access to proper health care due to the insurance companies interfering with the process. 
In recent years Kentucky has made several critical legislative moves to address the mental health challenges our state is facing. Our state wants to make mental health care more affordable and accessible to ensure individuals receive the care that they need. One of the most significant changes in mental health law in our state was Tim’s Law in 2017, which allows for court-ordered outpatient treatment for individuals who have been involuntarily hospitalized multiple times. The law is aimed at preventing a vicious cycle of hospitalization and release by ensuring those with severe mental illness remain in treatment. So instead of cycling through the system of state hospitals, or in many cases jails, Tim’s law gets people with the most severe mental illness into outpatient treatment. Tim's law has become a valuable tool is assessing the need for treatment in unique cases of mental illness. Recently, in June of 2022, Govenor Andy Beshear signed for two bills aimed at helping more individuals across the state access mental health services. The first bill, House Bill 127, expands access to assisted treatment. This bill allows the courts to order outpatient care for individuals with serious mental illnesses. This method is intended to ensure that every individual with a severe mental illness is guaranteed the treatment they need even if they do not have the means to access treatment on their own. Second the Govenor signed house bill 562 aimed getting first responders across the state access to the mental health care they need. The bill has sanctions allowing for peace officers, firefighters, EMS workers, and any other first responder to take 48 hours leave after being involved in a criminal incident. The incidents could refer to anything from a car accident to the death of a colleague. Each of these bills, House Bill 127 in particular, is aimed at expanding Tim’s law (2017) by allowing for greater access to those who would benefit from outpatient treatment by modifying the criteria for medical necessity. House Bill 127 also requires more thorough evaluation of individuals who may receive court-ordered treatment. Another way this Bill expands on Tim’s law is by helping to cover additional treatment costs necessary to ensure successful re-entry into the community. Our state has made big strides in making mental health care affordable and accessible to those who need it most.  
There are still more laws that need to be passed to reduce interference from insurers regarding those who still experience barriers to accessing treatment. In many states, including Kentucky, insurers are often able to set their own standards for defining when mental health services are medically necessary. This is alarming considering our state does not have any laws or sanctions that regulate how insurers conduct reviews of behavioral healthcare. This subjects both clients, and those in need of treatment, to the judgement of an insurer and prevents providers from being able to act morally given the constraints of their predicament. There is no guideline in the NASW’s code of ethics that specifies for providers how to balance the disparity of profit-motives and service to vulnerable populations and creates a persistent ethical challenge that many healthcare providers as well as policy makers must navigate. The federal Mental Health Parity and Addiction Equity Act of 2008 banned some of the harsher restrictions insurers had for those seeking treatment for mental health. However, since the passing of this act insurers have turned to utilization reviews, in which they can request progress notes from the providers which are full of sensitive details and as part of their assessment process. Healthcare providers have found that these reviews are only used as a means to dispute the necessity of further treatment. 
References  
Team Kentucky (2022). Gov. Andy Beshear Signs Two Bills Supporting Mental Health Access 
https://www.kentucky.gov/Pages/Activity-stream.aspx?n=GovernorBeshear&prId=1381#:~:text=Since%202017%2C%20Kentucky%2C%20along%20with,it%20out%20on%20their%20own. 
NASW. (2021) Code of Ethics of the National Association of Social Workers  
https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English 
Annie Waldman and Maya Miller (2024, August 27) What Mental Health Care Protections Exist in Your State? 
https://www.propublica.org/article/mental-health-wiltn-states 
Centers for Medicare and Medicaid Services. (2024). The Mental Health Parity and Addiction Equity act (MHPAEA). 
https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity 

Submitted by William King, BSW Practicum Student, University of Kentucky
 
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