Populations Affected
L.C. applies to the following groups of individuals whose impairments
result from mental illness:
- long-stay patients in state psychiatric hospitals who do not need to be
there;
- children in residential treatment centers who could be served in community
settings if services were available;
- residents in nursing homes who can appropriately be served in the community;
- individuals who frequently cycle in and out of hospitals, as a result of
a lack of community services;
- individuals institutionalized through incarceration in jail as a result
of failure to provide mental health services; and
- any other individuals who are receiving services in an unnecessarily segregated
setting.
To develop an effective plan, states must assess the number of people who
could reside in more integrated community settings and the services these individuals
require. The court indicated that a state may generally rely on the "reasonable
assessments" of its own professionals. However, there are situations in which
state professionals' decisions about the appropriateness of community services
may not be reasonable. The plaintiffs in L.C. relied on assessments
by their own treating professionals, but independent assessments are also valid.
States might begin by counting individuals in institutions who are already
on waiting lists for community placement, but for whom no appropriate community
referral has been identified. However, it is not uncommon for institutions
to judge an individual "not ready" for the community solely because no suitable
community placement is currently available. Evaluating an individual's appropriateness
for a community placement on the availability of services (or "slots") is not
a "reasonable" assessment of community readiness. The assessment must be based
on the individual's capacities and needs and on whether appropriately crafted
community services can meet those needs.
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