25 years ago tomorrow, a landmark decision by the US Supreme Court affirmed the rights of people with disabilities – including those with severe mental illness (SMI) and severe emotional disturbance (SED) – to live in the most integrated environment suited to their needs. The case involved two Georgia women – Lois Curtis and Elaine Wilson – who lived with intellectual disabilities and mental illness. At the time the lawsuit was filed, both plaintiffs were receiving mental health services in state mental institutions, even though experts believed they could be adequately served in a community setting. Known as the Olmsted decision (PDF 1.6 MB), the decision required states to eliminate unnecessary segregation and institutionalization of people who could benefit from community-based services. To this day, that decision continues to play a critical role in efforts to reform public mental health services across the United States.
At the time of the ruling in 1999, I was working in the Governor’s Office in Virginia, and I vividly remember the sense of validation and relief that so many felt, knowing that mental health conditions and substance use disorders (SUDs) were viewed as a disability in his eyes. court. The Olmsted The decision established the right to community life rather than institutional care for people with mental illness and other disabilities.
Over the years, many states have expanded their efforts to promote community inclusion and reduce reliance on institutional care for people with disabilities, including those with mental health conditions and SUDs. Yet too many continue to be in hospitals, nursing homes, and prisons and jails.
The importance of community living
Community living is a central tenet of SAMHSA’s mission. We believe that with the right support, virtually anyone can live successfully in the community. This includes people with SMI and SED, which can affect one’s life and ability to function. With timely and effective treatment and rehabilitation support services, many people with SMI and SED can more easily manage their conditions, overcome challenges, and enjoy meaningful, productive lives.
At SAMHSA, we outline four key cornerstones that support a life in recovery:
- Health: Overcoming or managing illness and making informed, healthy choices that support physical and emotional well-being.
- Home: Having a stable and safe place to live.
- Purpose: Carrying out meaningful daily activities such as work, school, volunteering and family.
- Community: Having relationships and social networks that provide support, friendship, love and hope.
From his passing Olmsted, people with SMI and SED now have more certainty that they can – and should – expect to achieve these four elements. However, these efforts to promote community living have not progressed smoothly, and much work remains at the national level to ensure that people with disabilities have meaningful opportunities to live and receive services at home and in their communities.
SAMHSA’s role in supporting people with behavioral disabilities
From the inadequate allocation of resources in public health and human services, to the lack of affordable housing and employment opportunities for people with disabilities, several factors have complicated the efforts of some people with health problems who seek to remain in or return to the community. As a result, too many continue to reside in nursing facilities, hospitals and other institutions. Some remain in prisons, jails and other criminal justice facilities due to inadequate access to necessary treatment and rehabilitation support.
SAMHSA has long recognized the importance of ensuring that individuals with behavioral health issues receive services in the most comprehensive setting appropriate for their needs. Numerous SAMHSA programs and initiatives help strengthen rights protections and address disparities in access to services and supports.
For example, since 1986 (and before Olmsted decision), SAMHSA has administered the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program, a type grant distributed annually to agencies in all 50 states, DC, five US territories, and the American Indian Consortium for Native Americans for abuse and neglect investigation ; address civil rights violations; and enforce the Constitution, federal laws and regulations, and state statutes, including adequacy of physical conditions in facilities, freedom from unreasonable restraint of liberty, due process in the event of involuntary treatment, and the right to informed consent for people with mental health disabilities. (There are Protection and Advocacy Systems for people with other types of disabilities, managed by our partners at the Administration for Community Living and the Department of Education.) One of the top priorities for PAIMI grantees is ensuring law enforcement for Americans with Disabilities under the Olmsted that govern their communities and help states manage risk through assessments and monitoring Olmsted plans to help avoid disputes. In fact, the PAIMI program in Georgia was instrumental in bringing it about Olmsted case in court.
SAMHSA also provides technical assistance and other opportunities to learn about federal rules, regulations, and tools available to support Olmsted and ADA implementation and compliance through a variety of SAMHSA-sponsored training and technical assistance centers and contracts.
Through the State TA Project (PDF | 2 MB), states can receive technical assistance and review best or evidence-based practices, evaluate their own systems, and determine how to transition individuals with mental illness and co-occurring SUDs to integrated, community living environments.
SAMHSA also maintains a detailed Olmstead-related webpage with guidance and resources. States and stakeholders can also view several free webinars for information on the process writing an Olmstead plan (1 hour, 31 minutes) or help to increase accessing community-based services for adults with SMI and children with SED (1 hour, 31 minutes)and strategies for how to work with counties to expand the availability of crisis services (1 hour, 26 minutes) which can help people avoid institutionalization.
SAMHSA also works with partners, including state behavioral health agencies, and other federal agencies, such as the Administration for Community Living, the HHS Office for Civil Rights, and the Department of Justice, to support the rights established by Olmsted.
SAMHSA’s commitment to Olmstead’s vision
Over the past 25 years, this country has made significant progress in protecting and enforcing the civil rights of people with disabilities – including those with mental illness and SUDs. Some of the changes states have made to comply with Olmstead are truly transformative. However, while we celebrate this success, we must also recognize that its promise Olmsted it remains unfulfilled for some people who continue to spend their lives in institutions without adequate access to community-based alternatives.
SAMHSA remains committed to strengthening states’ efforts to develop comprehensive, community-based systems of care aligned with the vision and guidance of the Olmstead decision. For more information, visit SAMHSA’s website with Olmsted resources.
