Are We Setting The Stage For Another Deinstitutionalization Debacle?

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Is the Justice Department setting the stage for another deinstitutionalization debacle  — this time by forcing group homes to close? Or will the Justice Department’s actions finally give us what we need: meaningful community based treatment, including housing?

I’ve been asking myself this question ever since I heard an inspiring story.

It was about a young man with intellectual disabilities who was able to move out of a group home into his own apartment where he didn’t have to share a bedroom or bathroom with random roommates for the first time in decades. He was able to do this because the state where he lived was forced to accommodate him by the Justice Department and what’s commonly called the Olmstead decision.

That decision came in a lawsuit filed by Lois Curtis and Elaine Wilson, who had mental illness and developmental disabilities, and were patients at a state run Georgia psychiatric unit. Doctors agreed that both women were ready to be discharged into a community-based program but no services were available so they continued to languish in the hospital. The women filed suit and on June 22, 1999, the United States Supreme Court ruled in Olmstead v. L.C. that unjustified segregation of persons with disabilities constitutes discrimination in violation of Title 11 of the Americans with Disabilities Act.

The Court held that public entities must provide community-based services to persons with disabilities when (1.) such services are appropriate; (2.) the affected persons do not oppose community-based treatment; and (3.) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.

The court said that “institutional placement” of individuals who can handle and benefit from living in a community “perpetuates unwarranted assumptions that persons so isolated (in institutions) are incapable of or unworthy of participating in community life.” The court added that “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement and cultural enrichment.”

I agree with the court’s ruling so why is the Olmstead decision causing me concern?

The answer is our history.

The idea of community-based treatment was established when President John F. Kennedy pushed passage of the Community Mental Health Act of 1963 through Congress. That law and a series of lawsuits set the stage for the great deinstitutionalization movement that effectively emptied and largely padlocked state hospitals.

Unfortunately, the lofty actions of the federal government and the court quickly turned into a cruel joke. States seized the opportunity to close costly hospitals but did not reinvest those savings in community mental health. The result: thousands of patients were simply pushed out onto the streets without a safety net.

It has been 51 years since Kennedy’s call for decent community based services. Judging from the National Alliance on Mental Illnesses’ state report cards, most states still aren’t providing them. Instead, individuals with the most severe mental disorders often are stuck in a revolving door between jails-prisons-and the streets.

Interpreting the law and enforcing it are what matters to the Supreme Court justices and Justice Department. But if our federal government is going to aggressively enforce Olmstead through its Justice Department, and it should, then isn’t that same government obligated to work through its other departments to insure states have adequate funding to guarantee that individuals with mental illnesses and intellectual disabilities receive the housing and support that they need?

If not, we will simply be going through round two of another deinstitutionalization debacle – with the federal government pushing residents out of group homes while telling state government to provide services that most are unwilling to do. The result will be more hardship on the citizens whose liberties the Justice Department claims it wishes to protect.

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.