Olmstead Case Study

Introduction

Video

http://www.youtube.com/watch?v=hmKz83CJgr4

History of Mental Health Discrimination in

America

Mental Health Segregation

• Family Care• Institutions & Asylums• Deinstitutionalization

Pre-legislation Cases

• O’Connor v. Donaldson• Rouse v. Cameron• Wyatt v. Aderholt

Disability Equality Legislation

• Rehabilitation Act of 1973• Developmental Disabled

Assistance and Bill of Rights Act of 1975

• Americans with Disabilities Act

Rehabilitation Act of 1973

• “No otherwise qualified individual with a disability … shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

Cases Interpreting the Rehabilitation Act

• Southeastern Community College v. Davis

• Alexander v. Choate

Developmental Disabled Assistance and Bill of Rights Act of 1975

• Right to receive “appropriate treatment” in “the setting that is least restrictive of … personal liberty.”

Pennhurst State School & Hospital v. Halderman

Americans with Disabilities Act (the

ADA)• “No qualified individual with a

disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.”

Omstead: The Case

Olmstead Facts

• Brought in 1995 by the Atlanta Legal Aid Society.– Plaintiffs: Lois Curtis (L.C.) and Elaine

Wilson (E. W.). Both women had mental retardation and psychiatric conditions.

• Both voluntarily admitted to Georgia Regional Hospital at Atlanta, where they were confined for treatment in a psychiatric unit.

• The State’s own professional teams concluded that they could discharged into community-based programs, but slots were not available, and the women remained institutionalized. – Therefore, no dispute that they were

“qualified.”

Alleged Violations

• Georgia health care officials, failed to afford them minimally adequate care and freedom from undue restraint

• Violation of their rights under the Due Process Clause of the Fourteenth Amendment.

Issue in Olmstead

• Issue in the case:– Whether the ADA requires states

to provide community placements for people with disabilities even if appropriate treatment can be provided in a state institution.

District Court Decision

• Granted partial summary judgment • Violation of Title II of the ADA.

– Ordering their placement in appropriate community-based treatment programs.

• Rejected the State’s arguments– That they had inadequate funding, and

was thus discrimination.– That requiring immediate transfers in

such cases would “fundamentally alter” the State’s programs.

Circuit Court Decision

• 11th Circuit – affirmed the District Court’s judgment.1. Found ADA not limited to discrimination

between disabled and non-disabled people and that institutional services were provided only to disabled individuals.

2. State’s duty to provide integrated services is not absolute. (Sometimes institutionalization is necessary. )• Unless it would be a “fundamental

alteration” in the state's provision of services.

• Remanded to determine “fundamental alteration” issue.

“Fundamental Alteration”• Allows the State to shows that…

– In the allocation of available resources…

– Immediate relief for the plaintiffs would be inequitable, given the responsibility the State has undertaken for the care and treatment of a large and diverse population of persons with mental disabilities.

Supreme Court Decision (Decided June 22, 1999)• The Supreme Court held that under Title

II of the ADA, States are required to place persons with mental disabilities in community settings instead of institutions when:

1. Their treatment professionals have determined that community placement is appropriate,

2. The community placement is not opposed by the individual, and

3. The placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.

“Reasonable Modifications” Standard

• Under Title II’s discrimination proscription, public entities must “make reasonable modifications” to avoid “discrimination on the basis of disability,” but does not require measures that would “fundamentally alter” the nature of the entity’s programs.

Discrimination?

• Undue institutionalization qualifies as discrimination “by reason of … disability.”

• The State contends that L.C. and E.W. were not discriminated against “by reason of” their disabilities because they were not denied community placement on account of those disabilities– And discrimination (defined by the

majority) requires uneven treatment of similarly situated individuals (and L.C. and E.W. had not identified a comparison class.)

Unjustified Institutional Isolation Constitutes

Discrimination• Consequences of Unjustified

Institutionalization:1. When people can handle and benefit

from community settings, institutional placement perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in the community.

2. Institutional confinement severely diminishes individuals’ everyday life activities.

Olmstead Dissent

(Thomas and Scalia)• Disagrees that they were

discriminated against “by reason of” their disabilities.

• Not traditional discrimination because it was only “temporary exclusion” from community placement.

Dissent Definition of Discrimination

• Under Title VII, a finding of discrimination requires:– A comparison of otherwise

similarly situated persons who are in different groups by reasons of certain characteristics provided by statute.

Dissent Says No Discrimination

“by reason of” their disabilities• “By reason of” has

previously been interpreted to require proximate causation.

• The women don’t contend that their disabilities constituted the proximate cause for the exclusion. Community placement simply was not available to those without disabilities!

The New Freedom Initiative

NFI 2001

• On June 18, 2001, President Bush signed the New Freedom Initiative

• The initiative is a nationwide effort to remove barriers to community living for people of all ages with disabilities and long-term illnesses.

• This initiative indicated that the executive branch was behind the deinstitutionalization efforts

Demonstrations of the Commitment to the NFI

• Congress, following Olmstead and the NFI, has committed funds to help the deinstitutionalization movement

• These focus of the various programs are not the same

• These many different efforts reflect the many different visions people have towards the implementation of Olmstead

Federal Aid for Infrastructure changes

• Examples of grants and programs for infrastructure change:– Real Choice

Systems Change– Money Follows

the Person Demonstration Grants

– Interview with Equip

States’ Efforts Towards Implementation

• The onus for implementation is on the States

• Here are some of the efforts made by the states to date:– Ohio’s Housing as Housing– California’s The Village

Integrated Service Agency– Maryland’s Housing

Unlimited– And Illinois…