National Alliance on Mental Illness
page printed from
(800) 950-NAMI;


By Stuart Broad, J.D.
Ron Honberg, J.D.


In 1970, 5,000 patients at Bryce Hospital in Alabama sued the state seeking improved conditions and increased access to appropriate treatment for patients at that hospital. In 1972, Judge Frank Johnson, then a Federal District Court judge, entered injunctions, setting forth minimal constitutional standards governing the rights of patients in state psychiatric and mental retardation facilities. Wyatt v. Stickney, 344 F. F. Supp. 373 (M.D. Ala., 1972). The impact of this decision extended far beyond Alabama. The standards set forth have been used as a template by advocates seeking improved conditions and services in institutional settings and in the community in many other states as well.

As the years passed, the scope of the Wyatt litigation expanded to address not only conditions within Alabama institutions but also the design and funding of mental health services in the community. Disagreements periodically arose between the parties as to the extent to which the state was complying with the standards set forth in the 1972 decision. In 1986, the court approved a consent decree resolving the parties differences over compliance with the standards and defining obligations of the state to comply with these standards.

In 1994, litigation resumed between the parties after extensive efforts to negotiate a settlement failed. After several interim decisions addressing defendants compliance and release from certain patients' rights standards and attorneys fees , this seminal litigation was finally settled in January, 2000.

Under the terms of the settlement, the state agreed to maintain improvements for current and future residents of mental illness and mental retardation facilities. The state also agreed to move an additional 600 patients with mental illness or mental retardation into the community over the next three years.

The state further agreed to hire qualified consultants within nine months who will study and write recommendations for the Alabama Department of Mental Health and Mental Retardation regarding discharge plans for residents with special needs. Additionally, the state agreed to a similar process regarding seclusion and restraints and the administration of psychiatric medications.

Finally, the state agreed to provide the Alabama Disabilities Advocacy Program (ADAP), the state's designated protection and advocacy program, with written notice of deaths, major personal injuries, suspected neglect, mistreatment, exploitation or abuse, and sexual assault of any residents of psychiatric or mental retardation facilities. The state also agreed to provide reports to ADAP of all deaths in facilities reasonably believed to be of other than natural causes, as well as a summary of its internal investigation of these deaths within 14 days after completion of the investigation.

No court-appointed monitor or other formal system of monitoring was established to oversee implementation of the settlement agreement.


Last year, the U.S. Supreme Court held that institutionalized individuals with mental disabilities have a qualified right, under Title II of the Americans with Disabilities Act (ADA) to services in the most integrated setting appropriate to their needs. L.C. v. Olmstead, 119 S. Ct. 2176 (1999). Recently, a Federal District Court in Pennsylvania approved a settlement agreement pursuant to the Olmstead decision in a case involving the closing of Haverford State Hospital. Kathleen S. v. Department of Public Welfare, 1999 WL 1257284 (E.D.Pa. Dec. 12, 1999).

The case was originally filed prior to the decision in Olmstead by residents of Haverford State Hospital alleging that the Commonwealth of Pennsylvania was failing to provide treatment in the most integrated setting appropriate to their needs. The trial court ruled in favor of these plaintiffs, and the Federal Court of Appeals for the Third Circuit ordered the parties to negotiate a fair settlement based upon Olmstead. An agreement was negotiated and the Third Circuit remanded back to the district court for review of the proposed settlement.

The District Court approved the settlement, with the modification that the commonwealth would be allowed additional time beyond the limits contained in the negotiated settlement to find appropriate community placements for those members of the plaintiff class deemed ready for such placements. The settlement also provides that the court will retain jurisdiction to enforce the rights of class members within 90 days after placements pursuant to the settlement.


Twenty three jurisdictions, including Indiana, allow judges to instruct juries on the consequences of insanity verdicts. Twenty six jurisdictions have adopted the position that an instruction of this nature is not necessary. The U.S. Supreme Court has held that jury instructions on the consequences of insanity verdicts are not necessary, except where the jury appears to be operating under a misconception as to the consequences of such a verdict. Shannon v. United States, 512 U.S. 573 (1994).

Recently, the Supreme Court of Indiana held that a criminal defendant in a murder case was entitled to jury instructions on the likely consequences of a "not guilty by reason of insanity" (NGRI) or "guilty but mentally ill" (GBMI) verdict after a prosecutor told the jury during closing arguments that an NGRI or GBMI verdict would result in freedom for the defendant. Caldwell v. Indiana, 722 N.E. 2d 814 (Ind. Sup. Ct. 2000). The Court reasoned that the statement by the prosecutor could prejudice the jury into believing that it had to find him guilty to prevent him from immediately returning to the community. The instruction, the Court reasoned, was therefore necessary to correct the erroneous impression left by the prosecutor. The Court therefore ruled that the trial court had committed reversible error by not providing the instruction, and ordered a new trial.


The Individual Educational Plan (IEP) for a child with severe emotional disturbance in Los Angeles County, California, provided for placement in a special class and school counseling once a week. A psychologist who evaluated the child at his mother's request recommended placement in a residential care program, but the school system did not comply. The child subsequently engaged in criminal behavior and came under the jurisdiction of a juvenile court. He was placed in a locked residential facility administered by the county. The county sought reimbursement from the mother for the costs of this facility.

The Court held that IDEA preempted the county's right to seek reimbursement from the child's mother. The child was subject to an IEP while detained in the residential facility. The services provided to the child in the facility included educational services. Thus, the county should have sought reimbursement through IDEA rather than from the child's mother.

County of Los Angeles v. Smith, 88 Cal. Rptr. 159 (Cal. Ct. App. 1999).


A woman with bipolar disorder was involuntarily committed to a hospital in Minnesota and was involuntarily administered Haldol. The commitment order was initiated after the woman refused life saving dialysis for her renal failure. The woman appealed the commitment order, arguing that her commitment and involuntary medication was a violation of the Minnesota law.

The Court of Appeals affirmed the commitment order. Failure to seek medical care for a life threatening condition is sufficient to meet the standard for commitment under the Minnesota law, the Court held. Given her pattern of denying her mental illness and her need for treatment, there is no evidence that she would have cooperated with a less restrictive alternative. Moreover, while Haldol was not the ideal option for pharmacological treatment in her case, it was the only option available at the time because it could be administered through injection.

Editors note: The name of this case is being withheld in the interests of protecting the confidentiality of the individual who was involved. The citation for this case will be provided upon request.