The Right to Live in the Community: Commemorating 25 Years of the Olmstead Decision

Tomorrow, 25 years ago, a landmark U.S. Supreme Court decision affirmed the rights of people with disabilities – including those with serious mental illness (SMI) and serious emotional disturbance (SED) – to live in the most integrated setting appropriate to their needs. The case involved two Georgia women – Lois Curtis and Elaine Wilson – living with intellectual disabilities and mental illness. At the time the suit was filed, both plaintiffs were receiving mental health services in state-run psychiatric institutions even though experts believed they could be appropriately served in a community-based setting. Known as the Olmstead decision (PDF 1.6 MB), the ruling required states to eliminate the unnecessary segregation and institutionalization of people who could benefit from community-based services. To date, this decision continues to play a critical role in efforts to reform public mental health services across the United States.

At the time the ruling was issued in 1999, I was working in the Office of the Governor in Virginia, and I vividly remember the sense of validation and relief so many felt, knowing that mental health conditions and substance use disorders (SUDs) counted as a disability in the court’s eyes. The Olmstead decision established a right to community living rather than institutional care for those with mental illness and other disabilities.

In the years since, many states have expanded their efforts to promote community integration and reduce reliance on institutional care for people with disabilities, including those with mental health conditions and SUDs; yet far too many continue to be in hospitals, nursing homes, and jails and prisons.

The Importance of Community Living

Community living is a central tenet of SAMHSA’s mission. We believe that with the right support, virtually anyone can successfully live in the community. This includes people with SMI and SED, which can interfere with someone’s life and ability to function. With early and effective treatment and recovery support services, many people with SMI and SED can more easily manage their conditions, overcome challenges, and enjoy meaningful, productive lives.

At SAMHSA, we describe four major cornerstones that support a life in recovery:

• Health: Overcoming or managing disease and making informed, healthy choices that support physical and emotional well-being.
• Home: Having a stable and safe place to live.
• Purpose: Conducting meaningful daily activities, such as a job, school, volunteerism, and family.
• Community: Having relationships and social networks that provide support, friendship, love, and hope.

Since the passage of Olmstead, people with SMI and SED now have more assurance that they can – and should – expect to achieve those four elements. However, these efforts to promote community living have not all gone smoothly, and much work remains nationwide to ensure people with disabilities have meaningful opportunities to live and receive services at home and in their communities.

SAMHSA’s Role in Supporting People with Behavioral Health Disabilities

From inadequate resource allocation in public health and human services, to a lack of affordable housing and employment opportunities for people with disabilities, several factors have complicated the efforts of some individuals with behavioral health conditions seeking to remain in or return to the community. As a result, too many continue to reside in nursing facilities, hospitals, and other institutional settings. Some remain in jails, prisons, and other criminal justice facilities due to inadequate access to the necessary treatment and recovery supports.

SAMHSA has long recognized the importance of ensuring that people with behavioral health conditions receive services in the most integrated setting appropriate to their needs. Numerous SAMHSA programs and initiatives help bolster rights protection and address disparities in access to services and supports.

For example, since 1986 (and prior to the Olmstead ruling), SAMHSA has administered the Protection & Advocacy for Individuals with Mental Illness (PAIMI) program, a formula grant distributed annually to agencies in all 50 states, D.C., five U.S. territories and the American Indian Consortium for Native Americans to investigate abuse and neglect; address civil rights violations; and enforce the Constitution, federal laws and regulations, and state statutes, including the adequacy of physical conditions in facilities, freedom from undue restraint of liberty, provision of due process in involuntary treatment, and the right to informed consent for people with mental health disabilities. (There are Protection & Advocacy Systems for people with other types of disabilities, administered by our partners at the Administration for Community Living and Department of Education.) One of the major priorities for PAIMI grantees is ensuring enforcement of the Americans with Disabilities Act under the Olmstead ruling in their communities and helping states with risk management through assessments and monitoring Olmstead plans to help prevent litigation. In fact, the PAIMI program in Georgia played a key role in bringing the Olmstead case to court.

SAMHSA also provides technical assistance and other opportunities to learn about federal rules, regulations, and available tools to support Olmstead and ADA implementation and compliance through a variety of SAMHSA-funded training and technical assistance centers and contracts.

Through our State TA Project (PDF | 2 MB), states can receive technical assistance and examine best or evidence-based practices, assess their own systems, and determine how to transition people with mental illness and co-occurring SUDs into integrated, community-living environments.

SAMHSA also maintains a detailed Olmstead-related webpage with guidance and resources. States and stakeholders can also view several free webinars for insight on the process of writing an Olmstead plan (1 hour, 31 minutes) or assistance in increasing access to community-based services for adults with SMI and children with SED (1 hour, 31 minutes), and strategies for how to collaborate with counties to expand the availability of crisis services (1 hour, 26 minutes) that can help people avoid institutionalization.

SAMHSA also works with partners including state behavioral health agencies, and other federal agencies such as the Administration for Community Living, the HHS Office of Civil Rights, and the Department of Justice, to support the rights established by Olmstead.

SAMHSA’s Commitment to Olmstead’s Vision

In the past 25 years, this country has made significant progress in protecting and enforcing the civil rights of people with disabilities – including those with mental illness and SUDs. Some of the changes states have made to comply with Olmstead are truly transformative. However, while we celebrate that success, we must also acknowledge that the promise of Olmstead is still unfulfilled for some people who continue to spend their lives in institutional settings without sufficient access to community-based alternatives.

SAMHSA remains committed to strengthening states’ efforts to develop comprehensive, community-based systems of care aligned with the Olmstead decision’s vision and guidance. For more information, please visit the SAMHSA site with Olmstead resources.