Olmstead v. L.C.

Read the Bazelon Center's Statement on the 5th Anniversary of the Olmstead Decision (6/21/04) Bazelon Center Resources on the Olmstead Decision Background and Additional Information on the Olmstead Decision Olmstead Implementation News Publications, Articles and Reports Other Legal Resources from the Bazelon Center for Mental Health Law Other ADA Supreme Court Cases Tennessee v. Lane & Jones (2004) Medical Board of California v. Hason (2003) Chevron v. Echazabal (2002) University of Alabama v. Garrett (2001) Sutton, Murphy and Kirkingburg Decisions (1999) Bazelon Center Civil Rights and the Americans with Disabilities Act Issues Page

On June 22, 1999, the United States Supreme Court held in Olmstead v. L.C. that the unnecessary segregation of individuals with disabilities in institutions may constitute discrimination based on disability. The court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities. This historic pronouncement makes attainable a goal long-sought by people with disabilities and advocates.

Background and Additional Information on the Olmstead Decision

• Background on the case
• The Supreme Court's Opinion
• Olmstead v. L.C. Supreme Court Briefs
• For an account of the final settlement, with an update on the plaintiffs' success in the community, visit Atlanta Legal Aid's page.
• More on the Supreme Court's Decision
• The President's June 18, 2001 executive order directing federal agencies to assist states with Olmstead implementation.

Olmstead Implementation

News

• Legal Advocate Cites Ongoing Segregation on Eve of Olmstead Anniversary (6/21/04)
• California Settlement Takes First Step Toward Olmstead Compliance (1/5/04)
• Advocates: Lack of Services Means More Jail Time for NY Parolees with Serious Mental Illnesses (10/21/03)
• Lawsuit Seeks Community Integration of Thousands of New Yorkers with Mental Illnesses (7/1/03)
• Older People with Mental Illnesses Remain Unnecessarily Segregated in Nursing Homes, Institutional Settings (3/10/2003)
• Rights, Recovery Stressed at Mental Health Commission Meeting (2/10/03)
• Testimony of Michael Allen, Bazelon Center for Mental Health Law, to the President's New Freedom Commission on Mental Health (2/5/03)
• Bazelon Center Presents Lost in the System: Community Integration on Trial (11/15/02)
• Virginia Agress to Issue Rules Ensuring Access to Community Services for People with Mental Retardation (9/4/01)
• U.S. Supreme Court To Review Crucial Decision for Inclusion of People with Disabilities (3/18/99)

Publications, Articles and Reports

• Olmstead: Where Are We After Five Years By Jennifer Mathis
• Just Like Where You and I Live: Integrated Housing Options for People with Mental Illnesses
  This March 2004 article is presented in PDF format; You will need the free Acrobat Reader to view and print it.
• Last in Line - Barriers to Community Integration of Older Adults with Mental Illnesses
  This February 2003 publication looks at the persistent segregation of older Americans with mental illnesses and provides a prescription for reform
• Merging System of Care Principles with Civil Rights Law: Olmstead Planning for Children with Serious Emotional Disturbance
  This November 2001 report reviews of the status of states' planning for the development of community-based children's services.
• Under Court Order
  paper with policy recommendations and financing strategies to help states avoid an undue burden from implementation of the Supreme Court's decision. Lists an array of service options that, when properly configured, can supplant institutional care and promote community membership. HTML format, or PDF. You will need the free Acrobat Reader to view the PDF file.
• Article in PDF format on states' implementation of Olmstead by Bazelon Center staff attorney Jennifer Mathis from the November-December 2001 issue of Clearinghouse Review: Journal of Poverty Law and Policy.

Other Legal Resources from the Bazelon Center for Mental Health Law

• Brief on Budget Neutrality*: In this amicus brief, state commissioners, directors, and administrators from eleven states argue that the moderate and temporary costs associated with desegregation do not fundamentally alter a mental health system and, thus, are not an adequate reason to exempt states from the Americans with Disabilities Act's community integration mandate. This is a PDF file; you will need the free Acrobat Reader to view it. (12/18/02)
• Advocacy strategies for implementation of the other three ADA decisions issued by the Supreme Court on June 27, 1999, and a list of limitations on major life activities by individuals with psychiatric disabilities.
• Currie v.Hartford Life Insurance Company, a case that explored Olmstead's implications for long-term disability insurance
• Bazelon Center Legal Director Ira Burnim's Congressional Testimony on the ADA's Integration Mandate

More on the Decision

In a 6-3 opinion authored by Justice Ruth Bader Ginsburg, the court affirmed a ruling by the United States Court of Appeals for the Eleventh Circuit that unjustified isolation of individuals with disabilities is properly regarded as discrimination based on disability. The court held that unjustified segregation in institutions is discrimination not only because it perpetuates unwarranted assumptions that people with disabilities are incapable or unworthy of participating in community life, but also because confinement in an institution severely curtails everyday life activities, such as family relations, social contacts, work, educational advancement and cultural enrichment.

Nonetheless, the Supreme Court held, the states' need to maintain a range of facilities for the care and treatment of individuals with diverse mental disabilities must be recognized. In determining whether a state can successfully assert a "fundamental alteration" defense (i.e., claim that providing community-based services to an individual would fundamentally alter the state's service-delivery system), courts must consider not only the cost of providing community-based care to the litigants, but also the state's obligation to mete out services to others with mental disabilities in an equitable manner. If the state can show that 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," it will meet the fundamental alteration defense. For example, Justice Ginsberg wrote, if the state demonstrates that it has a "comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings, and a waiting list that move[s] at a reasonable pace not controlled by the State's endeavors to keep its institutions fully populated," an individual cannot skip to the top of the waiting list by filing a lawsuit to obtain community services; such a move would not be a reasonable modification.

Finally, the court held that a state may generally rely on the "reasonable assessments of its own professionals" in determining whether a community-based placement is appropriate. Additionally, the ADA does not require that community-based treatment be imposedonn individuals who oppose it.

The Olmstead decision should encourage states to begin planning implementation strategies to comply with the ADA's integration mandate, spelled out in regulations requiring that services be provided "in the most integrated setting appropriate to the needs" of people with mental or physical disabilities. All states have already begun moving in the direction of providing more mental health services in community-based settings. Nonetheless, to comply with the integration mandate, state mental health officials will need to take significant steps to move institutionalized people more quickly into more integrated settings.

The court heard the Georgia case on April 21, 1999. The suit had been brought by two women with both mental retardation and psychiatric conditions who were patients in a state hospital. Their treating professionals agreed that the women should be served in community programs, but no slots were available for them. Supporting Georgia's appeal to the Supreme Court, some states argued that, while "virtually any person can safely and appropriately be served in his or her home (or in the most integrated community setting)," the cost of doing so would be unduly burdensome.