Ensuring community-based options for persons diagnosed with mental health problems
By Avina Krishna, Law Clerk
Today marks the 24th anniversary of the Americans with Disabilities Act of 1990 (ADA), the civil rights law that prohibits discrimination based on a physical or mental disability. This summer also marks the 15th anniversary of the landmark Supreme Court decision of Olmstead v. L.C., which found that persons with mental disabilities have the right to receive community-based care instead of being institutionalized. Today’s post will briefly describe each of these milestones in mental health law in the United States and highlight their applications today in ensuring youth with mental illness have access to services that allow them to remain in their own homes and communities.
Building on the Benefits of ADA: Celebrating Olmstead
There is widespread agreement among experts that treating people with mental illness outside of mental health institutions creates positive long-term effects such as sustained improvements in social, emotional, and behavioral functioning. Community-based services also increase effectiveness of mental health treatment, allow for greater autonomy for persons with mental health disabilities, and can be more cost-effective.
Before the ADA and Olmstead, people affected by mental health problems or developmental disabilities would have remained in an institution or asylum for the majority of their lives. As observed in the Olmstead decision, “institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable of or unworthy of participating in community life. . . . 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.”
Olmstead expanded the rights offered under the ADA by establishing that preventing a person from receiving community-based healthcare was a form of discrimination. Olmstead also created the standard for determining treatment types for those in need of mental health care.
The Faces of Olmstead: Lois Curtis and Elaine Wilson
Lois Curtis and Elaine Wilson, the named-plaintiffs in Olmstead, had dual diagnoses of serious mental disorders and developmental disabilities. They had both received treatment in institutional and community-based settings in the state of Georgia. Following clinical assessments, mental health professionals concluded that both women would be better off in a community-based treatment setting. However, because community-based services were in short supply, Lois and Elaine remained in the hospital.
In 1995, the Atlanta Legal Aid Society filed suit against the State of Georgia on behalf of Lois and Elaine for depriving them, and thousands of others, the opportunity of living outside of the institution and in their own communities.
Several years later, in a landmark decision, the Supreme Court affirmed that mental illness is a form of disability and that institutional isolation of a person with a disability is a form of discrimination under the ADA. Further, such discrimination “perpetuates unwarranted assumptions about their capabilities and their worthiness to participate in community life. The Court found that institutional confinement deprives people of most of what is valued in life: family relations, social contacts, work, educational advancement and cultural enrichment.”
As the case moved through the courts, Lois and Elaine were both moved to community treatment facilities. Their struggle helped pave the way for many more people living with mental health problems and developmental disabilities. While Elaine died in 2005, Lois was able to fully transition into her community and is now a professional artist. Lois is a prime example of how persons with developmental disabilities and mental illness can thrive when given the opportunity to be productive and engaged parts of their communities.
Providing a Solid Foundation for Improving Mental Health Coverage for Foster Youth
Although Olmstead ensured better options for persons affected by mental illness, access to community-based services still eludes many low-income young people. Class action lawsuits in several states, including Katie A. v. Bonta in California, are seeking to improve access to intensive home and community-based mental health services for youth.
Building on the ADA and Olmstead, the parties in Katie A. reached an agreement in 2011 that established intensive in-home and community-based services and supports are part of youth’s entitlement to mental health services under the Federal EPSDT Medicaid program and thus must be provided by the state of California to foster youth. Currently, Young Minds’ attorneys, serving as co-counsel for the Plaintiffs, are closely monitoring the rollout of Katie A. services statewide. Once fully implemented the settlement will help expand access to home and community-based mental health services to as many as 40,000 youth in California.
The discourse around the need for community-based mental health services has improved over the past 25 years, thanks to the tireless efforts of people like Lois and Elaine as well as mental health advocates and other stakeholders. However, the battle to ensure that all people living with mental illness, including youth, have access to the least restrictive care possible is far from over, and only through continued advocacy and education can there be a solution.