Mental Health and Criminal Cases

No one may be tried, convicted or sentenced while incompetent to stand trial. Under Kentucky law, a defendant is incompetent if, because of a mental condition, he or she cannot appreciate the nature and consequences of the case or participate rationally in his or her own defense. Competency is about the defendant’s condition now, not at the time of the alleged crime.

If the court has reasonable grounds to believe a defendant may be incompetent, at arraignment or any later stage, it must order an evaluation.

1. 1The court can order an outpatient examination by an examiner from a facility designated by the Cabinet for Health and Family Services.
2. 2If the examiner finds an inpatient evaluation is needed, the court can commit the defendant to a forensic psychiatric facility for up to 30 days. The state’s forensic hospital for this work is the Kentucky Correctional Psychiatric Center in LaGrange, which performs competency and criminal responsibility evaluations and treatment to restore competency.
3. 3The examiner files a sealed report within 10 days after the examination, and the court holds a status conference or hearing within 30 days after the report is filed.
4. 4If the court finds the defendant competent, the case continues.

If there is a substantial probability the defendant will regain competency within 360 days, the court orders treatment for up to 60 days and then holds another hearing. A defendant charged with a felony is treated at a forensic psychiatric facility unless the cabinet chooses another of its facilities.

If there is no substantial probability of regaining competency, the case cannot be tried while the incompetency lasts. For the most serious charges, including capital offenses, Class A felonies, Class B felonies causing death or serious physical injury, and first-degree rape or sodomy, the Commonwealth’s Attorney’s office must ask the Circuit Court to begin an involuntary commitment proceeding. For other charges, the court holds a civil involuntary hospitalization proceeding.

Insanity concerns the defendant’s condition at the time of the offense. Under current Kentucky law, a person is not criminally responsible if, at that time and because of mental illness or intellectual disability, he or she lacked substantial capacity to appreciate the nature and quality of the conduct. A condition shown only by repeated criminal or antisocial conduct does not qualify.

A defendant who plans to raise insanity or other mental health evidence must give written notice at least 90 days before trial, and the prosecution may ask for its own examination. A person found not guilty by reason of insanity is not simply released: the court must hold an involuntary hospitalization proceeding and may hold the person for up to 10 days while it begins.

A jury or judge may find a defendant guilty but mentally ill when the prosecution proves guilt beyond a reasonable doubt and the defendant proves, by a preponderance of the evidence, that he or she was mentally ill at the time of the offense. The sentence is the same as for a guilty verdict, but treatment is provided while it is served and is a condition of any probation or parole.

If treatment is still needed when the sentence ends, the treating professional or the Commonwealth must ask the court for hospitalization or court-ordered outpatient treatment. A jury may not find a defendant not guilty by reason of insanity on one count and guilty, or guilty but mentally ill, on another count from the same course of conduct in the same trial.

Kentucky’s Behavioral Health Conditional Dismissal Program lets some adults charged with a misdemeanor or Class D felony complete a treatment plan for a mental health or substance use disorder instead of ordinary prosecution. Completing the program, which generally lasts at least a year, leads to dismissal and sealed records. Violent offenses, sex crimes, DUI and certain domestic violence cases do not qualify, nor do people with prior convictions for Class A, B or C felonies. In felony cases the Commonwealth’s Attorney must agree to participation after consulting any victim. The program runs as a pilot until January 1, 2031, only in counties chosen by the Chief Justice. On the cabinet’s most recent published list, from early 2026, Campbell County was not a participating county.

Involuntary hospitalization of a person who is not facing criminal charges is a separate civil process. It begins in District Court, and the County Attorney represents the Commonwealth in those cases.