THE MENTAL HEALTH GAP IN DISABILITY RIGHTS

This blog post is chapter 3 in a four-part series reflecting on the legacy and significance of the Americans with Disabilities Act (ADA). Written by Yair Oded and Jesús Veliz; edited by Jennifer Mathis.

August 27, 2025

The central goals of disability rights advocacy are full access, inclusion, independence, equal opportunity, and full participation in everyday life, in clear alignment with the promise of the ADA. The ADA applies equally to people with mental health disabilities, but too often the ADA and disability rights principles are absent from conversations about mental health. Rather than emphasizing autonomy and community integration, the discourse about mental health advocacy frequently pivots to institutionalization and clinical treatment — a reductionist framework often summed up, not without irony, as “meds and beds.”

People with mental health disabilities are still too widely perceived through a lens of suspicion and control. In addition to being stereotyped as incapable of making their own decisions, they are often treated as dangerous or threatening. This prejudice persists despite overwhelming data showing that people with mental health disabilities account for only 3 to 5 percent of violent acts and are far more likely to be victims of violence than perpetrators. Too often, it has been used to justify a focus on coercive strategies and divert attention from investment in meaningful, community-based care.

“The fact that somebody else can decide how a person is living is not appropriate,” says Sara Kenigsberg, a filmmaker and mental health rights advocate. “They can lose their rights because somebody has made a subjective decision that they’re either a danger to themselves or others, or they’re not living what is deemed normal.”

Nowhere is this more evident than in the continued overreliance on institutionalization. Decades ago, we began to shift service systems away from reliance on institutional care and toward community-based services that allow people to live full lives in their own homes and communities. The mental health field recognized that keeping people institutionalized on a long-term basis in the back wards of state psychiatric hospitals was not only damaging to people’s lives but was not providing effective treatment, and moved toward using psychiatric hospitals instead on a short-term basis for acute episodes. Yet we continue to see a surprising amount of advocacy for expanding institutional care rather than addressing the large gaps in our community service systems that cause people to be admitted or stay longer than necessary in hospitals or other institutions — despite decades of proven successes demonstrating that community-based, person-centered care leads to better outcomes at lower costs.

“Instead of thinking about how we can exhaust every option before we turn to involuntary commitment, a lot of these bills are just like, ‘No, let’s do this,’ ” says Vesper Moore, a psychiatric survivor and national mental health advocate. “There’s no question about what it means for the human rights of the person when we’re institutionalizing [them] on the basis of their disability.”

He went on to share his personal experience with institutionalization. “The confluence of the trauma that I experienced led to me struggling with thoughts and feelings of suicide. I ended up hospitalized as a teenager, and seeing what the mental health acute units were like, what the state hospital system was like, the harms that were perpetuated in institutions and overlooked were striking to me.”

The Trump administration has doubled down on institutionalization and force, championing punitive and segregationist policies that threaten to roll back hard-won rights. His recent Executive Order, for example, encourages states to expand the use of civil commitment — a process by which individuals can be involuntarily hospitalized. The same order calls for defunding ‘Housing First’ programs, which are now widely used because of a robust body of research and experience showing their effectiveness. This approach provides permanent housing without conditioning it on treatment compliance, since denying housing to those who cannot comply often leaves the people with the greatest needs without help or effective engagement.

At the same time, Congress’s so-called One Big Beautiful Act slashes Medicaid funding — the single most important source of support for community-based services for people with disabilities. The bill passed despite widespread opposition from healthcare providers, disability advocates, and civil rights groups. It threatens to undo decades of progress by cutting off access to health coverage for millions of people and services that allow people with mental health disabilities to remain in their homes, engage with their communities, and live with dignity.

Stay tuned for chapter 4, where we explore successful examples of community-based care and the future of the deinstitutionalization movement.

Join the Bazelon Center in marking the 35th anniversary of the ADA at our Annual Awards Reception, taking place Wednesday, September 17, 2025, from 6:30–9:00 PM ET at the National Press Club in Washington, D.C. Get your tickets and event details here.