National Alliance on Mental Illness
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Supreme Court Recognizes ADA Right to Community Placement

By Katy Scheflen, Staff Attorney

On June 22, the U.S. Supreme Court issued its ruling in L.C. v. Olmstead, No. 98-536, a case that posed the question of whether States have an obligation to treat persons with mental disabilities in the most integrated setting possible. In L.C., two individuals who had been institutionalized filed suit against the state of Georgia, alleging that the State violated Title II of the Americans With Disabilities Act (ADA) by failing to place them in the community and provide them with the services they needed to remain there.

The Supreme Court's decision can be viewed as a qualified victory for persons suffering from mental illnesses. Georgia officials had argued that, although a community setting may be more desirable for some individuals presently institutionalized, to deny them such placement does not constitute discrimination. Justice Ginsburg , writing for the majority, squarely disagreed, stating that "unjustified institutional isolation" is indeed a form of discrimination.

This conclusion was based on two underlying principles. First, that the institutional placement of persons who are capable of living in a community setting perpetuates "unwarranted assumptions" that such persons are "incapable or unworthy of participating in community life." Second, that such isolation "severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment." The fact that this principle is now settled as a matter of law represents a solid step forward for those who have suffered discrimination through unjust deprivation of the opportunity to live in the community. However, the Court left open major issues which will effect the implementation of community placement for those individuals deemed capable of living outside of an institutional setting.

The Court held that the State's responsibility to provide community-based treatment is not boundless, and that States need only make "reasonable modifications" to comply with the law. This standard allows a State to refuse to put into place modifications which constitute a "fundamental alteration" of the State's services and programs. In determining the reasonableness of

providing community-based treatment, the Court of Appeals allowed for a cost-based analysis that measured the cost of providing community treatment for an individual against the State's entire mental health budget. The Supreme Court rejected this construction. Instead, the Court decided, the reasonable-modifications regulations allows a State to show 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." The end result of this less stringent construction is a that the State will have more discretion in making community versus institutional placement decisions, at least in relation to the less deferential Court of Appeals standard.

This interpretation of the reasonable modifications standard is necessary, the Court reasoned, to preserve the State's discretion in maintaining a range of institutional and community facilities. The Court made it clear that the ADA is not reasonably read to impel States to phase out institutions, or as a way to move institutionalized persons into inappropriate settings, such as a homeless shelter. However, the Court failed to establish what level of services are necessary to ensure adequate treatment in the community. Essentially, the decision does not guarantee that the States will develop systems of community care that effectively address the needs of people with severe mental illness.

Finally, the Court is vague about how long an individual can be made to wait to be placed in community treatment. In addressing the State's discretion in maintaining a range of institutional and community facilities and services, the Court noted that the non-discrimination mandate of the ADA could be satisfied if there was a "comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings and a waiting list that moved at a reasonable pace." While this language provides a rudimentary standard by which to measure state systems, the question of what constitutes a "reasonable pace" is left unanswered.