NYAPRS Note: In the most recent publication from the Bazelon Center for Mental Health Law, they review how the ADA has been upheld through legal proceedings that have led to further community integration for persons with psychiatric disabilities. As NY begins to implement the transition of Adult Home residents into community residences, it is important to recognize where we have come from to get our system to this point, and how much work is still to be done to provide meaningful community integration for all persons with disabilities. The excerpt from the report “A Place of My Own” below details how the Olmstead decision was held up in NY, providing residents of impacted homes the opportunity to move to supported apartments in 2014.
The ADA’s Integration Mandate and the Olmstead Decision
Bazelon Center; A Place of My Own: How the ADA is Creating Integrated Housing Opportunities for People with Mental Illnesses, 3/2014
The ADA, enacted in 1990, was intended “to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities.” Title II of the ADA prohibits discrimination based on disability by state and local government entities. In the ADA’s findings, Congress recognized the longstanding problem of isolation and segregation of people with disabilities, stating that:
- “historically, society has tended to isolate and segregate individuals with disabilities, and, despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem;
- “discrimination against individuals with disabilities persists in such critical areas as . . . institutionalization . . . ;
- “individuals with disabilities continually encounter various forms of discrimination, including outright intentional exclusion, . . . failure to make modifications to existing facilities and practices, . . . [and] segregation . . . .”
Congress’s findings apply to all people with disabilities, including people with mental illnesses. The ADA’s application to segregation is particularly relevant to individuals with serious mental illnesses, who have a long history of being physically segregated in state hospitals and other congregate facilities, resulting in negative stereotypes and social isolation.
In 1999, the Supreme Court interpreted the ADA’s integration mandate in Olmstead v. L.C.,19 a case brought by two women with mental illness and intellectual disabilities who challenged their continued confinement in a state psychiatric hospital after they had been determined ready for discharge. The Court held that needless institutionalization was a form of discrimination prohibited by the ADA. According to the Court, this holding reflected two evident judgments. First, needlessly institutionalizing individuals with disabilities “perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.” Second, “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.” States must offer services in community settings to interested individuals who are needlessly institutionalized unless doing so would fundamentally alter their service systems.
In Disability Advocates Inc. v. Paterson, later vacated on other grounds, a federal district court considered ADA integration claims brought by approximately 4,000 individuals with mental illness living in large, segregated board and care homes called “adult homes.” These are among the outdated facilities that, many decades ago, had been used by states to downsize their state psychiatric hospitals. The lawsuit involved adult homes with at least 120 beds and where at least 25 percent of the residents had a mental illness (individuals with mental illness constituted about 80 percent of the overall population of the homes in question). The court held that New York was violating the ADA’s integration mandate by administering, planning and funding its mental health system in such a way that, for thousands of individuals with mental illness, adult homes were the only residential option available.
While the adult homes are not operated by the state, the state is “responsible for determining what services to provide, in what settings to provide them, and how to allocate funds for each program.” The State “plan[s] how and where services for individuals with mental illness will be provided, and . . . allocate[s] the State’s resources accordingly.” The State licenses, monitors, inspects, and regulates adult homes, and has the power to determine their availability.
Applying the principles set forth in Olmstead, the district court found that adult homes are institutions that segregate people with mental illness from the community, that supported housing is a more integrated setting than adult homes (and the most integrated setting for virtually all adult home residents with mental illness), that virtually all adult home residents with mental illness are qualified to live in supported housing, and that many of these residents would choose to live in supported housing if afforded a meaningful choice. Accordingly, the district court held that New York discriminated against DAI’s constituents by needlessly institutionalizing them in adult homes. While a federal appeals court vacated the decision based on a finding that the plaintiff, Disability Advocates, Inc., did not have standing to bring the case, it left untouched all of the findings of fact and conclusions of law concerning the merits of the case.
The adult homes case was ultimately refiled as a class action case, and the United States Justice Department brought its own action against the state based on the same facts—New York’s continued needless segregation of individuals with mental illness in adult homes. The two cases were filed together with a settlement agreement between the class of adult home residents, the Justice Department, and New York. That settlement was approved by the court and requires the state to develop supported housing for thousands of adult home residents with serious mental illness. It is described in the section below concerning Olmstead settlement agreements.
The case has been cited by many other courts, and the reasoning of the decision has been reflected in many subsequent community integration lawsuits and court decisions.
Access the full document ‘A Place of My Own’ detailing housing opportunities through the ADA by going to the Bazelon website.