Managed care, pension payments causing problems for community mental health centers; Edelen, C-J call for changes

"Kentucky mental health centers are cutting back services and struggling to assist patients the first time they’re admitted because of ongoing struggles with Medicaid managed care," Don Weber reports for cn|2. "At the same time, they’re losing out on federal grants because of red flags caused by their administration costs being inflated by increasing contributions to the public pension system."

NorthKey Community Care Mental Health Center in Northern Kentucky, which serves eight counties, had to close its adult day-treatment programs for the seriously mentally ill. Dr. Owen Nichols, the president and CEO, told Weber, “I get calls periodically from elderly parents in the community wanting help with their adult child that suffers from schizophrenia because they’re now wandering the streets, having some difficulties with local authorities.”

A recent editorial in The Courier-Journal addresses Kentucky's need for better mental health treatment, saying that Kentucky has "an underfunded, fragmented and now —thanks mostly to Medicaid managed care —hopelessly complicated system of mental health care."

The editorial notes last week's C-J articles in which reporters Laura Ungar and Chris Kenning uncovered the problems families face when navigating a fragmented mental-health system while trying to provide appropriate treatment for a loved one suffering form a severe mental illness, in addition to the "F" grade Kentucky received for its poor mental-health funding.

The editorial also describes how structural issues with managed care, which began in November 2011, have complicated the state's mental-health system. It notes the community mental-health centers asked to be left out of managed care, "pointing out they already operate efficiently and amount to only about 3 percent of the state’s $6 billion a year Medicaid program."

In addition, the editorial notes, "State Auditor Adam Edelen recommended the Cabinet for Health and Family Services take mental health out of managed care and let the state resume running it." Against his advice and the requests of community mental-health centers, the state expanded managed care of mental health. Now some haven’t been paid for Medicaid services since January, when managed care took effect, the editorial says.

"The nightmare needs to end for the many Kentuckians who need basic mental health services," says the editorial. "It’s time for the state to fully explore this system and, if folks are serious about improving it, fix the problems and find the money to fund it." (Read more)

Kentucky families struggle to care for violent, mentally ill children, and say their plight has been made worse by managed-care firms

Kentucky families struggle to care for violent, mentally ill children, and say their plight has been made worse by managed-care companies that fragment mental-health care and make it harder to find appropriate, stable treatment, which ultimately places the larger public at risk, Laura Ungar reports for The Courier-Journal.

Ungar writes that the lives of these Kentucky families resemble in part the one that lead to a devastating outcome in Newtown, Conn., where 20-year-old Adam Lanza, who had poor mental health and was under his mother’s care, went on a shooting rampage in an elementary school and killed 20 students and six staff members.

To represent the Kentucky families fighting, this battle, Ungar tells the story of the Davies family, who battle to keep themselves safe from the violent rage of their 14-year-old daughter, Lucy, while struggling to find the help she needs. Lucy has threatened to kill her 16-year-old sister, Katie, and herself, she’s tried to throw Katie and her father Dan down the basement stairs, and she’s been abusive to her mother.

Lucy suffers from a long list of disorders: neurological problems from fetal alcohol spectrum disorder, a mood disorder, post-traumatic stress disorder, and cognitive difficulties, Ungar reports. "Since Lucy was adopted at age 9, she’s received fragmented treatment in more than six facilities and doctors’ offices, none of which have been able to stop her violent outbursts," Ungar writes. Now, her Medicaid managed-care insurer, Coventry Cares, won’t cover her treatment in an Illinois facility called NeuroRestorative, which Ungar says offers her the best chance at improvement.

"The care tracking is just so fragmented, and we have managed-care companies that determine from afar what care people can get. They go from provider to provider. It’s a tragedy," said Louise Howell, president of Buckhorn Children and Family Services, where Lucy was treated briefly before becoming too violent for the staff. “This child is a perfect example of someone in need of a strong therapeutic community," Howell said. "And there’s so many of them."

Before going to Buckhorn, Lucy was at Rivendell Behavioral Health Services in Bowling Green, where she received brief treatment after threatening to kill her sister. From Buckhorn she got an emergency transfer to Our Lady of Peace in Louisville, which could handle her high level of violence. She was released when she moved from the Medicaid plan Kentucky Spirit, which plans to break its contract with the state, to Coventry Cares, with which Our Lady of Peace had severed ties.

Lucy's mother told Ungar that every switch of caregiver and facility increases the trauma to her daughter, who desperately needs stable care. Lucy’s parents say she would have such stability at NeuroRestorative, where her fetal alcohol syndrome could be addressed on a long-term basis. But two doctors working for Coventry, who have never examined Lucy, told her parents that Conventry "won’t cover the placement because there’s no evidence that inpatient care for brain trauma is medically necessary," Ungar reports.

Her eyes full of tears, Cynthia Davies told Ungar, “You cannot look into my daughter’s eyes and tell me she doesn’t deserve care. She’s a human being.” (Read more)

Essential-benefits rule expands mental-health and substance-abuse coverage; Ky. needs more facilities to treat newly eligible

The Department of Health and Human Services has defined the 10 "essential health benefits" insurance plans must provide, and it included benefits for mental health and treatment of substance-abuse disorders..

Nearly 20 percent of Americans don't have access to mental-health services and over 30 percent have no coverage for substance-abuse treatment. This rule will expand mental health and substance-abuse treatment benefits to 62 million Americans, according to HHS.

Expanded coverage for mental health and substance abuse treatment programs in Kentucky could bring about a dramatic shift in the delivery of these services. There is already a shortage of treatment options and centers for Kentuckians, and those suffering from addiction have not had coverage for such treatment; the proposed rule will change that.

Recovery Kentucky, a public-private partnership with residential facilities, was created to help Kentuckians recover from substance abuse. It has 10 centers, in Campbellsville, Erlanger, Florence, Harlan, Henderson, Hopkinsville, Morehead, Owensboro, Paducah, and Richmond, according to the 2012 Justice & Public Safety Cabinet report, which included the map below. 

Health-insurance plans must cover the 10 essential benefits beginning in 2014, so the state must prepare for the newly insured in addition to newly covered services. The rule defines what must be covered in insurance plans and bans discrimination based on age or pre-existing conditions. Among the core package of items and services, known as “essential health benefits" are items and services in the following categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

States are given flexibility in implementing the federal health-care reform law with a benchmark approach. The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange. HHS will review the recommendation and accept public comments prior to making a final decision. (Read more)

Report says veteran suicide rate is up from 2007

Almost every hour in this country, on average, a veteran commits suicide. The Department of Veterans Affairs reported that 22 veterans per day took their own lives in 2010, up four a day from the 2007 rate. Perhaps contrary to public perception, the report said most suicides occurred among veterans over 50. It recognized Vietnam-era veterans as a risk group, as well as female veterans.

Military service members come disproportionately from rural areas. Kentucky has two army posts, Fort Knox and Fort Campbell.

(Among active service members in 2012, more died from suicide than in combat, we reported here. The Army said Friday that 325 soldiers committed suicides last year; if the tentative number is confirmed, it would be a historical high. "If that bleak total remains at 325, the toll in 2012 would have risen by 15 percent over 2011 when the Army sustained 283 suicides," NBC News reported.)

Reactions to the VA report ranged from encouragement to outrage. The VA pointed out that the daily veteran suicide rate has "remained relatively stable over the past 12 years," but the percentage of the overall national suicide rate accounted for by veteran suicide has actually decreased.  Veteran suicides accounted for about one-fifth of American suicides in 2010, down from one-fourth of suicides in 1999.

The VA said that showed its programs are working, but promised to take "immediate actions." NBC reported that "the top strategy" on the VA's agenda was an already-established task force that could help suicide screening identify warning signs earlier.

Some groups were dismayed by the VA report and demanded more action. Iraq and Afghanistan Veterans of America called for more research and collaboration. "The country should be outraged that we are allowing this tragedy to continue," IAVA found and CEO Paul Rieckhoff told NBC.

On Feb. 13, the U.S. House Committee on Veterans' Affairs will hold a hearing on veterans and mental health care. The Veterans Crisis Line -- 800-273-TALK -- is available for veterans who are concerned about their mental health. (Read more)

More child-welfare indicators added to Kids Count data site

Kentucky Youth Advocates has added four new child welfare indicators to the agency's Kids Count Data Center. These four new indicators provide Kentuckians and those who report on them with more information on vulnerable children and families in the state.

One new indicator shows the prevalence of certain risk factors -- substance abuse, mental health issues, and income -- in cases where child abuse or neglect was found to have occurred after an investigation was done. Another new indicator include the numbers of children community members bring to the attention of the state Department for Community Based Services due to suspicions of child abuse or neglect. (Read more)

Kids Count provides information across states and for Kentucky counties and school districts on many measures of child well-being, including economic well-being, education, health, and safety. To find the data center, go here.

Federal official and expert on integrating physical and behavioral health services will speak in Louisville Wednesday morning

The integration of physical health and behavioral health services, one of the hottest topics in health care, will be the topic of a Health Enterprises Network forum in Louisville Wednesday, Oct. 3.

The speaker will be Kathleen Reynolds, director of the federal Center for Integrated Health Solutions, vice president of health integration and wellness for the National Council for Community Behavioral Healthcare and author of Raising the Bar: Moving Toward the Integration of Healthcare. She will review the landscape of integration, discuss how it will affect Kentucky, and offer ideas on how health-care organizations can accomplish it.

The forum will be held from 8 to 9:15 a.m. Oct. 3 at the University of Louisville's Clinical and Translational Research Building, 505 S. Hancock Street. The registration fee for members of the Health Enterprises Network is $45; non-members $60; full-time students $10. For more information call 502.625.0179 or email Register@HealthEnterprisesNetwork.com.

Searching for a fundamental 'particle' of mental health

The discovery of the Higgs particle, which gives matter its mass, was a huge breakthrough for scientists since "confirming its existence was imperative to a full scientific understanding of the world," and its has an equivalent that has yet to be found when it comes to mental health, forensic psychiatrist Erik Roskes writes for The Crime Report.

The equivalent of the "Standard Model" of mental health — Higgs plays an essential part in the "Standard Model" of physics — is a world in which "people are not penalized for their illnesses but rather than an array of tools from which to choose and which they can use to become mentally healthy," Roskes writes.

Though those tools have not yet been identified, there are paths down which researchers are going to find them, including molecular and pharmaceutical research; psychotherapies and rehabilitation. Research has led to pharmaceutical approaches, "not perfect, but far preferable to a world without them," he writes. It has led to cognitive therapy to treat depression, anxiety and, in some cases, psychosis. It has also led to advances in rehabilitation of mental illnesses and developmental disabilities like autism.

Like the search for the Higgs particle, finding its equivalent in the world of mental health is worth the search, Roskes concludes. (Read more)

Online training could help rural doctors offer better mental health care

More than half of all U.S. mental health care takes place at the primary-care level, and that percentage is even higher in rural areas, where mental-health doctors are often hundreds of miles away, reports Newswise, a research-reporting service. A new online training program could help rural primary-care doctors better treat patients with mental health issues, and that could be important in Kentucky.

The Behavioral Health Education Center of Nebraska, a part of the University of Nebraska Medical Center, designed the program. Educational Director Howard Liu said primary care doctors are overwhelmed by the amount of mental health care they must provide. Newswise reports "the goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists." The adolescent version of the program was released last fall and is being used by doctors worldwide. The adult and geriatric version will be released this spring.

Primary care doctor Angie Brennan estimates 35 percent of all visits to her practice have been mental health related. She said there are specific rural challenges to treatment, including "reluctance to see a counselor and a lack of mental health insurance coverage – combined with an intensified fear that someone in the community will find out a patient has mental health issues." (Read more)

Amid legislative action on 'Larry's Law,' report says mentally ill and intellectually disabled don't belong in personal-care homes

By Tara Kaprowy
Kentucky Health News

As state legislators move to change the procedure for admitting mentally ill patients to personal-care homes, a new report argues those patients shouldn't be in the institutions at all — and neither should people who have intellectual disabilities.

Kentucky Protection & Advocacy, an independent state agency, argues personal-care homes promote "congregate" and "segregated" living arrangements and, as such, run counter to the Americans with Disabilities Act and a court decision saying disabled patients  should live in the "most integrated setting," meaning one "that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible."

The report is based on data collected from 218 people in 20 of Kentucky's more than 80 free-standing personal-care homes. Of the facilities visited, 85 percent of the residents living there either had a mental-health diagnosis or an intellectual disability. The visits were unannounced, and individuals were asked at random if they wanted to participate in the survey.

The report found residents in personal-care homes are often restricted from their community either because of lack of transportation — nearly 43 percent said they had to walk in order to go anywhere — or because the home is geographically isolated from most of the community. Staff also rarely plan outings, with one in three respondents saying it never occurs. Another 14 percent said it happens "a couple times a year" and 14 percent said it happens weekly.

Though community mental health centers have programs for counseling and rehabilitation, only 13 percent of personal-care home residents said they go. "Many residents expressed interest in attending the therapeutic rehabilitative programs and the community mental health center for counseling or case management services; however, the staff at PCH would not arrange it," the report reads.

Adding to the argument that residents live in a congregate arrangement, the report points out residents are "subjected to regimented meal times, often with assigned seating, medication, smoke breaks, curfews and bedtimes;" have roommates but are not able to choose them; are not always allowed to refuse to take their medication; and have limited visiting hours.

Still, when asked if they have any complaints about living in a personal-care home, 51.2 percent said they didn't. Nearly 46 percent said they did, and 3.2 said they were unsure. Being lonely or having nothing to do was the single biggest complaint. To download the report in PDF form, click here.

Two bills have been filed to change the way people with mental illness or intellectual disability would be admitted to personal-care homes. Senate Bill 115, which the Senate Health and Welfare Committee approved today, would require that a potential resident receive a medical exam that includes a medical history, physical exam and diagnosis before being admitted. The same would be required by House Bill 307, which would also require more assessment for a person with an acquired brain injury. It hasn't seen action since it was posted in committee Feb. 6. 

The bills are dubbed "Larry's Law," after Larry Lee, who disappeared in August from Falmouth Nursing Home. Lee, who had a brain injury from childhood, had been diagnosed with schizophrenia, bipolar disorder and diabetes. He was found dead four weeks after his disappearance on the banks of the Licking River, which flows through Falmouth. (Read more)

"Larry Lee is not the first person to walk away from a personal care home and die," Beth Musgrave and Valarie Honeycutt Spears write for the Lexington Herald-Leader, citing cases from Grant and Letcher counties. (Read more)

Extensive series focuses on the many faces of mental illness

Mental illness in Rowan County is the subject of an eight-part series of stories written by Noelle Hunter for The Morehead News.

With Part 1 largely an introduction to the project, Part 2 gets into the facts and figures of the disorders that fall under the mental-illness umbrella. According to the Substance Abuse & Mental Health Services Administration, 45.9 million American adults — one in five — experienced some mental illness in the past year. In Kentucky, 180,000 people live with a serious mental illness, which includes schizophrenia, bipolar disorder, major depression, obsessive compulsive disorder, panic disorder and post-traumatic stress disorder.

Dr. Thomas Insell, director of the National Institute of Mental Health, described mental illnesses as "real brain disorders that result from complex genetic risks plus environmental factors." Neither prevalence nor mortality rates associated with mental illness have decreased over time. And though there have been advancements in treatments these disorders, most in the way of medication and therapy, there is still much that is unknown, Hunter reports.

That comes with larger cultural ramifications. In 2008, about 5,100 adults who have a mental illness were incarcerated in Kentucky prisons and almost 700 adults committed suicide, "almost always a result of untreated mental illness," Hunter reports.

The series is running on Tuesdays in the twice-a-week paper. Part 3 profiles a woman living with bipolar disorder; Part 4 will report on the views of clinicians and therapists; Part 5 will profile a man living with bipolar disorder; Part 6 will profile a person living with schizophrenia; Part 7 will focus on the effects on families; and Part 8 will look at treatment options and recovery. The website of the newspaper, part of Community Newspaper Holdings Inc., is here.

2009 U.S. suicide rate highest in 15 years; 600 Ky. teens in 2010

The year 2009 had the highest number of suicides in 15 years, data collected by the Centers for Disease Control and Prevention indicate.

Between 2008 and 2009, the suicide rate increased 2.4 percent, with 36,909 suicide deaths nationwide. In 2008, 13.4 percent of people who committed suicide had either job or money issues, reports research-reporting service Newswise. Numbers are expected to rise, with the National Suicide Prevention Lifeline reporting a 14 percent increase in call volume between 2010 and 2011.

Between 2008 and 2009 about 8.3 million adults (nearly 4 percent of the U.S. adult population) said they had serious thoughts about suicide in the past year, CDC data show. More than 2.2 million adults reported making plans for suicide in the past year and more than 1 million adults said they attempted suicide in the past year. (Read more)

About 600 Kentucky teens died by suicide last year, reports Jennifer Hewlett for the Lexington Herald-Leader.

Bills would require more assessment before a patient can be admitted to a personal-care home

Legislation dubbed "Larry's Law" is aimed at preventing what happened to Larry Lee from happening again.

House Bill 307, filed by Democratic Rep. Terry Mills, right, "would require an individual to be examined and assessed by a medical professional before admission to a personal care home, and it would require further assessment of the degree of disability for an individual with an acquired brain injury who was being considered for placement," report Valarie Honeycutt Spears and Beth Musgrave of the Lexington Herald-Leader.

Senate Bill 115, filed by Republican Sen. Jimmy Higdon, left, would require that a potential resident be evaluated by a mental health professional before someone is admitted to a personal care home, a cost that would be picked up by the state. Higdon and Mills are both from Lebanon, where Larry Lee lived until he went to Falmouth Nursing Home in Pendleton County.

In August, Lee, right, disappeared from the home, one of 82 free-standing personal care homes in Kentucky. Lee, who had a brain injury from childhood, had been diagnosed with schizophrenia, bipolar disorder and diabetes. He was found dead four week after his disappearance on the banks of the Licking River, which flows through Falmouth.

A pre-admission assessment "is the only thing that we found that could have saved Larry Lee," Higdon said. "His condition was too severe. He should have never been in a personal care home." (Read more)

Rosalynn Carter Fellowships help journalists report about mental health; applications due April 16

The Carter Center Mental Health Program is providing six Rosalynn Carter Fellowships for journalists to report on a selected mental-health or mental-illness topic for one year. The center overseen by former president Jimmy Carter says its intention is to increase accuracy in reporting about these issues and decrease the prevalence of incorrect and stereotypical information.

Applicants must have at least three years of professional experience in print or electronic journalism. If selected, they will be required to attend orientation and presentation meetings at the beginning and end of the fellowship year. They will also be awarded a $10,000 stipend, but will not be required to leave their current job.

Those wishing to participate must submit a completed application by April 16, 2012. Awards will be announced July 13, 2012. For more information and the application packet, click here.

Monday, Oct. 10 is World Mental Health Day

Oct. 10 is World Mental Health Day, observed with the aim of raising public awareness about mental health issues. On average, Kentuckians report four mentally unhealthy days per month.

Adults in Pike County reported having the most days a month — seven — that they felt stressed, depressed or emotionally unstable. Those in Daviess, Fayette, Henderson, Mason, McCracken and Webster counties reported the lowest number of mentally unhealthy days. County-by-county data can be found by clicking here.

The theme of this year's day, as decided by the World Health Organization, is "Investing in Mental Health," with the purpose of highlighting the funding shortages that exist to treat people with mental health. In Kentucky, mental health has received the same amount of funding in the state budget each year for the past 15 years.

Second death in five years raises questions about placement of mentally ill Kentuckians in personal-care homes

The second death in five years of a mentally ill person who has walked out of a personal care home has "prompted advocates for the brain injured and the mentally ill to question whether personal care homes, which do not provide skilled nursing care, are the appropriate place to house people who have serious, chronic and complex problems," Beth Musgrave and Valarie Honeycutt Spears report for the Lexington Herald-Leader.

Larry Joe Lee, 32, who "had a brain injury, was schizophrenic, bipolar and diabetic," was found dead in after walking away from the Falmouth Nursing Home, the writers note. "In 2007, Larry Bruce Huff, 64, who had schizophrenia and a history of alcoholism, walked away from Golden Years Rest Home in Letcher County and later froze to death." The state closed Golden Years last week, and legislators say they will address the overall problem in the 2012 General Assembly.

"Personal care homes provide long-term care for people who do not need full-time nursing home care but need some assistance," the newspaper explains. "They receive a small state stipend and social security disability — $1,194 a month — to provide services to a complex population that includes the mentally ill, mentally disabled and even those who have recently been released from prison. There are 82 free-standing personal care homes in Kentucky serving more than 3,000 people." (Read more)

Caregivers of wounded soldiers find their lives are also changed; getting compensation

The wars in Iraq and Afghanistan disproportionately affect rural areas, which provide more than the average number of recruits. The soldiers who make it home alive come back changed, with traumatic brain damage, post-traumatic stress syndrome or other injuries that require full-time care. Mostly wives and older parents are left bearing the burden.

Catrin Einhorn of The New York Times reports that many caregivers have to quit their jobs and are forced to spend their savings and retirement funds to pay for treatment. A growing number of caregivers suffer from anxiety, depression and exhaustion as a result of their new routines. Rosie Babin, 51-year-old mother of a severely wounded 22-year-old son, was managing an accounting office before her son's injury. Though she's happy to have her son home alive, she now has to take blood-pressure medicine and sleeping pills. "I felt like I went from this high-energy, force-to-be-reckoned-with businesswoman to a casualty of war," Babin told Einhorn. "And I was working furiously at not feeling like a victim of war."

According to research by Joan Griffin, a research investigator with the Minneapolis Veterans Affairs Health Care System, most of the injured are in their 20s and 30s, making this the first time since Vietnam the V.A. has seen such an influx of youth, which extending the length of care to years and sometimes decades. On average, Griffin found that family members spend more than 40 hours a week providing care, making it nearly impossible for them to keep a job.

Organizations like the Wounded Warrior Project have tried to ease the financial burden on these families by lobbying Congress to provide direct compensation and other benefits to caregivers and their families. In 2010, the veteran's agency approved 1,222 applications and awarded monthly stipends of $1,600 to $1,800 to caregivers. Along with the money, they can receive health insurance and counseling, Einhorn reports. This law only applies to caregivers of service members injured after Sept. 11, 2001, and it's uncertain who will qualify and how compensation will be determined.
(Read more)

Fellowships of $10,000 available for reporting on mental health

Each year the Carter Center Mental Health Program awards six Rosalynn Carter Fellowships for Mental Health Journalism to six American journalists. They get a stipend of $10,000 to report on a mental health topic of their choice. "The fellowships are designed to increase accurate reporting on mental health issues and decrease incorrect, stereotypical information," says a release from the center founded by former president Jimmy Carter.

The deadline to apply is Monday, April 18. Applicants must have at least three years of professional experience in print or electronic journalism, submit an application packet and attend orientation and presentation meetings in September at the beginning and end of the fellowship year. Fellows are not required to leave their current employment. Awards will be announced July 15, 2011. For more about the program and an application packet, click here.

Longtime legislator gets national award for helping mentally ill

State Rep. Jimmie Lee of Elizabethtown, left, today received the national Jacob K. Javits Award, an honor given to legislators who advocate for mental health services.

"It just blows my mind that someone from Kentucky wins, and it was me," Lee told Marty Finley of his hometown paper, The News-Enterprise.

Lee, who has served as a legislator since 1993, was chosen for the honor due to his efforts to expand services for the mentally ill. His efforts include helping to replace the Eastern State Hospital in Lexington, obtaining funding for community mental health centers, and helping to open a new crisis stabilization unit in Louisville.

Lee is the first Kentucky legislator to be chosen for the award. To recognize his achievements, the Kentucky General Assembly passed resolutions that made today Jimmie Lee Day. (Read more)

Three Ky. physicians and one nurse practitioner investigated for high numbers of prescriptions for antipsychotic drugs

State and federal officials are investigating three Kentucky doctors and one nurse practitioner because of the unusually high amounts of antipsychotic drug prescriptions they write for Medicaid patients.

In 2008 and 2009, the four wrote the most prescriptions in the state for Abilify, Geodon, Seroquel, Zyprexa and risperidone, antipsychotic drugs that can cost up to $10 a pill, The Courier-Journal's Laura Ungar reports.

Somerset psychiatrist Dr. Zev Zusman wrote 6,556 prescriptions in 2008 and 2009, resulting in $2.2 million in Medicaid charges.

Mount Sterling's Dr. Samuel Welch, left, wrote 5,881 prescriptions, costing taxpayers $1.9 million.

Deborah Bradford, an Owensboro-based nurse practitioner and psychologist, wrote 4,279 prescriptions, at a cost of $1.2 million.

Paducah-based Dr. Duncan Darnell, a child and adolescent psychiatrist, wrote 3,536 prescriptions, costing $1.1 million.

Welch and Darnell defended their practices. Welch, the medical director of Pathways Inc., said he sees about 20 patients a day in a 10-county area. "The biggest chunk of what I do is see patients for medications," he said, adding that other psychologists provide talk therapy.

Darnell, the medical director at Four Rivers Behavioral Health, said he prescribes for more than 1,000 of his own patients, as well as sometimes prescribing for patients cared for by another psychiatrist and a nurse practitioner. "The folks I end up seeing are often very mentally ill," he told Ungar. "For me, medicines are used as a last resort."

Tracking the prescription levels is part of "a federal review into concerns about over-prescribing, waste and health care fraud in an era of tight government budgets," Ungar reports. Sen. Chuck Grassley, R-Iowa, is leading the review, and has asked every state to list the top 10 prescribers for certain medications. (Read more)

Bill filed to keep guns from those judged to be mentally ill

Keeping guns out of the hands of the mentally ill is the aim of House Bill 308, which was filed last week by Rep. Bob Damron, D-Nicholasville.

"We want only the right folks to be able to buy a firearm," said Damron, right. "That does not include the mentally ill. I think most gun owners would stand behind that." Damron is an ally of the National Rifle Association.

The bill covers a loophole in state law. Though the federal Brady Handgun Violence Prevention Act of 1993 requires background checks when someone buys a gun and prohibits the sale of guns to people "adjudicated as a mental defective or who has been committed to a mental institution," Kentucky does not require courts to give their mental health records to the FBI, The Lexington Herald-Leader's John Cheves reports. Since 1998, Kentucky has only submitted four records.

Damron's proposal would require state courts to inform the Kentucky State Police when someone is adjudged mentally incompetent or sent to a mental institution. The KSP would then notify the FBI, which in turn would add the names to the National Instant Criminal Background Check System. The names would only be those of mentally ill people who have been documented by the courts. Those who voluntarily commit themselves to a mental institution or who are treated for mental health issues would be protected by privacy laws.

The gap in the law, which exists in many states, went under a national microscope when Seung-Hui Cho killed 32 people and himself on the Virginia Tech campus in 2007. More than a year before the shooting, a judge had deemed Cho dangerously mentally ill following a stalking incident. When Jared Loughner killed six people and injured many others, including U.S. Rep. Gabrielle Giffords, in Tucson, Ariz., the gap again gained national attention. However, Loughner is not known to have been a patient in an institution, so it is not clear if his mental health issues were documented. (Read more)