Addictions and Mental Health The Olmstead Decision and Oregon’s Olmstead Plan Implications for...

Addictions and Mental Health

The Olmstead Decision and Oregon’s Olmstead Plan

Implications for Coordinated Care Organizations

Residential Transition to CCOs

Learning Session Four

Webcast: February 28, 2014


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Presenters

Micky Logan, JDLegal Affairs Director

Oregon State Hospital

Nicole CurrierProject Coordinator

Mental Health America – Oregon

Rick WilcoxCommunity Transition/Olmstead Coordinator


Oregon Health Authority


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Introduction

The 1990 Americans with Disabilities Act (ADA) established the rights of persons with disabilities to live productive, meaningful lives and to be fully integrated into the communities in which they live.

– The Olmstead vs. L.C. United States Supreme Court decision of 1999 further clarified these rights extend to persons experiencing mental illness and intellectual disabilities.

– The court further directed that states make reasonable efforts to ensure their mental health service delivery systems complied with the Olmstead decision.


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Introduction

• CCOs should collaborate with stakeholders to promote this philosophy because:

– Right thing to do– Improve treatment outcomes– Lower overall costs

• CCOs can assist stakeholders in accomplishing a needed paradigm shift

– Planful use of high intensity treatment resources– Increased emphasis on recovery vs. symptom management– Increased opportunities to promote independence and community

integration for plan members


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Table of Contents

• A Brief History of the Americans With Disabilities Act and the Olmstead Decision

• Explanation of Concepts

• Challenges to Integration

• A Brief History of Implementation Efforts

• Summary of Oregon’s Olmstead Plan

• Implications for CCOs


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Americans with Disabilities Act

The 1990 Americans with Disabilities Act (ADA) confirmed that persons with disabilities have the right to equality in:

» Employment;

» Housing;

» Education; and

» Community Access

And are entitled to reasonable

accommodation to ensure this equality


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Olmstead vs. L.C. - 1999

Lawsuit against the State of Georgia• Determined that it is a violation of the ADA to treat persons with

intellectual disabilities/mental illness in a segregated setting when they could be effectively served in a less restrictive more integrated setting.

• Segregation reinforces:

– The myth that persons with disabilities are incapable of participating in society

– Isolation and exclusion from everyday life


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Olmstead principles

• ADA Integration Mandate- requires that state and local governments : “administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities”

• Consumer Choice- The ADA and the subsequent “Olmstead” Supreme Court decision address civil rights. The most basic of human rights is the freedom to make life choices; consumers should have the freedom to decide what type of living arrangement they want and what services they choose to use.


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What is Reasonable Accommodation?

• Decided on a case-by-case basis

• Title II of the ADA requires– Public entities make “reasonable accommodation” unless to do so

entails a “fundamental alteration” of the entity’s services, programs, or activity

• Fundamental Alteration– Decided on a case-by-case basis


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What is an integrated setting?

• State hospital?

• Own apartment/home?

• Locked program in the community?

• Adult foster home?

• Homeless shelter?

• In my own apartment in a complex exclusively for individuals with mental illness?

• Tent in the park?

• A group home where I can come and go as I please, and be as involved as I want in the activities of my community?


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Institutions according to Olmstead

• State and acute care hospitals

• Residential treatment facilities

• Group homes

• Adult foster homes

• Prisons/jails

• Any congregate setting with more than 20% of units reserved for persons with disabilities


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Characteristics of institutions

• Congregate/group living not of the resident’s choosing

• Restricted egress-locked doors, staff escort

• Externally imposed schedule

• Curfews

• House rules

• No choice of roommates

• Mandatory participation in services to retain housing


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Challenges to integration

• Previous Paradigms

• Inflexible funding streams

• Fear

• Residential or “group home” models

• NIMBY (Not in My Back Yard)


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Back to the Olmstead decision

1999-2009– June 19, 2001, executive order authorizes the United States

Attorney General, and the Secretaries of Health and Human Services, Education, Labor, and Housing and Urban Development to work together to ensure “swift implementation”

– Numerous lawsuits and briefs filed nationwide, eventually resulting in several settlements, most notably in Georgia, where Olmstead vs. L.C. was filed


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Back to the Olmstead decision

2009-Present– Obama Administration makes Olmstead enforcement a priority

– More lawsuits and settlements

– More investigations by the US Department of Justice

– Growing consumer/survivor voice

– Building momentum


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Oregon’s Olmstead plan

• Olmstead Plan

• Five principle areas of focus:1. Preventing State Hospitalization

2. Reducing State Hospital Length of Stay

3. Ensuring Individuals Get The Services They Need

4. Housing and Supported Housing

5. Expanding the Quality and Availability of Community Supports


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Oregon’s Olmstead Plan

• Provide sufficient community resources to avoid hospitalization and reduce utilization of costly resources

• Increase consumer voice in state and local mental health agencies

• Empower consumers with increased choice of options

• Enhance strategies to promote local decision making regarding resources, as well as promoting accountability for outcomes

• Encourage community integration

• Promote “unbundling” housing from services

• Encourage “outside the box” thinking to meet individual consumer need


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What does this mean for CCOs?

• Increased ability to avoid crisis (and high cost interventions) through utilization of community based strategies

• Increased utilization of Peer Support and Traditional Health Workers focusing on wellness and recovery

• Close collaboration with Community Mental Health Programs to wrap services in the community


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Further information

Bazelon Center for Mental Health Law

www.bazelon.org

Center for Personal Assistance Services

www.pascenter.org

Disability Right Oregon

www.disabilityrightsoregon.org

Substance Abuse and Mental Health Services Administration www.samhsa.gov

http://www.bazelon.org/

http://www.pascenter.org/

http://www.disabilityrightsoregon.org/

http://www.samhsa.gov/


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Contacts

Micky Logan503-947-2937

[email protected]

Nicole Currier503-922-2377

[email protected]

Rick Wilcox503-945-5955

[email protected]

mailto:[email protected]



Addictions and Mental Health The Olmstead Decision and Oregon’s Olmstead Plan Implications for...

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