www.loubar.org 4 Louisville Bar Briefs PROFESSIONAL EXCELLENCE The Modernization of Kentucky’s Civil Commitment Statute, KRS 202A A patient-health focused approach that improves public safety Judge Stephanie Pearce Burke Kentucky’s civil commitment law, primarily codified in Chapter 202A of the Kentucky Revised Statutes (KRS 202A), originated from the nationwide transformation of mental health law during the mid-20th century. The statute’s development demon- strated a transition away from policies of institutionalization that prioritized segrega- tion of individuals with mental illness and developmental disabilities into overcrowded state-run facilities. This approach relied on containment rather than treatment and the isolation of individuals from the public at the lowest possible cost. Some efforts towards deinstitutionalization began in the mid-1950’s after the develop- ment of the first antipsychotic drug, Thora- zine; however, federal efforts to move people into community-based care formally began with President John F. Kennedy’s signing of the Community Mental Health Act in 1963. Substantial reform was implemented only after public outcry over human rights viola- tions, and the system moved toward more constitutional protections and due process. Before the current civil commitment statute was enacted, Kentucky addressed involun- tary hospitalization through earlier “lunacy” or “insanity” laws dating to the late 19th and early 20th centuries. These statutes primar- ily emphasized custodial confinement over treatment and offered minimal procedural protections. In the 1960s and 1970s, deinstitutionaliza- tion, advances in psychiatric medicine and evolving constitutional due process juris- prudence transformed mental health law throughout the United States. Landmark cases such as O’Connor v. Donaldson (1975), Addington v. Texas (1979) and Lessard v. Schmidt (1972) significantly shaped the development of Kentucky’s present-day civil commitment framework. Kentucky established its current involun- tary commitment struc- ture in the 1970s through KRS Chapter 202A. This statute modernized state law by prioritizing judi- cial oversight, procedural safeguards, dangerousness criteria and the principle of using the least restric- tive alternative for treat- ment. The most significant ad- vancement was the adop- tion of the “dangerous- ness” standard. Under the current version of KRS 202A, commitment requires the court to find that an individual has a mental illness, poses a danger or threat of danger to self or others, can benefit from treatment and that hospi- talization is the least restrictive alternative mode of treatment presently available. This standard remained unchanged for more than 50 years until the Kentucky General Assembly made sweeping amendments to the statute during the 2026 legislative ses- sion. These amendments will take effect on October 1, 2026. 2026 Modernization of KRS 202A House Bill 485 was sponsored by Represen- tatives Jason Nemes, Kim Moser and Lisa Willner. It was the product of months of collaboration among legislators, the Ken- tucky District Judges Association, the Ken- tucky County Attorneys Association, the Kentucky Commonwealth’s Attor- neys Association, mental health practitioners and many mental health advo- cacy groups, including the Kentucky Mental Health Coalition. The bill passed the House 95-0 and was ultimately attached to Sen- ate Bill 122 in the final days of the 2026 session. SB122 then passed the Senate 37- 0, and the law was enacted by the Governor’s signature on April 10, 2026. The 2026 amendments to KRS 202A constitute the most significant reforms to Kentucky’s involuntary commitment system in nearly half a century. These revisions update procedures, clarify legal standards and are intended to enhance coordination among courts, hospitals, law enforcement and mental health providers to more aptly benefit the patient and protect the public. Under previous legal frameworks, individu- als could experience severe psychosis, disor- ganization, inability to care for themselves or escalating psychiatric decline without meeting the threshold for intervention, as they had not yet posed an “immediate threat” of physical harm. A key change in the legislation expands the definition of dangerousness to include “psychiatric deterioration.” This revision acknowledges that serious mental illness often worsens progressively rather than solely through sudden acts of violence or suicidality. For years, mental health experts have called for revising Kentucky’s “dangerous” criteria, noting that mental health practitioners lacked the legal authority to help individuals with a documented history of serious men- tal illness who were experiencing clinical decline until they reached the most severe possible condition. The revised statute recognizes that “psychi- atric deterioration” itself may pose substan- tial risks. Individuals experiencing severe psychiatric decline may stop eating or sleep- ing, be unable to secure shelter or medical care, lose contact with reality or engage in dangerous, self-destructive behavior. The reform also reflects growing recognition of anosognosia, the neurological inability of some individuals with serious mental illness to recognize their condition. By enabling earlier intervention, the revised statute aims to reduce recurrent crises, incarceration, “ The 2026 amendments to KRS 202A constitute the most significant reforms to Kentucky’s involuntary commitment system in nearly half a century. (Continued on next page)
