Implementation of the US Supreme Court Case Olmstead vs. LC
(Go right to What Happened?)
Background
The Olmstead case was filed on behalf of two women, L.C. and E.W. who were dually diagnosed with mental illness and mental retardation and institutionalized in a Georgia State Psychiatric Hospital. These individuals wanted to live in the community and the professionals providing their treatment had determined that their needs could be met in the community. The state of Georgia, however, did not have any suitable community placement so both women remained hospitalized.
In 1999 the Supreme Court found that unjustified isolation in an institution is discrimination based on disability and a violation of the Americans with Disabilities Act (ADA). But the Court clarified that ADA does not require an end to institutional placement for those who need it. The Court affirmed that the judgments of treating professionals should be given broad discretion, and that community placements should not be imposed on patients who do not want them. States were urged to develop a comprehensive plan for placing qualified people in less restrictive settings and establishing a waiting list that moves at a reasonable pace to place people in appropriate community settings. States also were directed to identify individuals at-risk for being placed into an institution and develop community services to prevent hospitalization.
North Carolina has taken the position that the case offers an opportunity to strengthen the community system. The State has expanded the planning process to include populations not specifically named in the lawsuit, including children and substance abusers. The General Assembly recently appropriated $3 million for Olmstead planning and initial funds to develop community services for individuals who desire and are capable of leaving institutions. The Department of Health and Human Services has initiated a comprehensive planning process that will provide a report and recommendations to the General Assembly on how to proceed. NAMI North Carolina has been actively involved in this planning process.
Advocacy in the Legislature
The Governor did not increase funding support for Olmstead implementation in his budget. A request to provide additional funding to support community services for people leaving state institutions is contained the Coalition 2001 budget request (H380 & S369) for funds to address the needs of individuals on waiting lists for MH/DD/SA services
Compliance with the Olmstead decision will require the development of a wide array of community support services. In perhaps the greatest scare of the session, the Senate proposed closing several institutions, including Dorothea Dix hospital and Whitaker School. No funds were proposed to develop services for these individuals in communities. The public outrage and subsequent advocacy by NAMI North Carolina and other organizations resulted in a proposal championed by Sen. Marc Basnight and Sen. Steve Metcalf to establish a MH/DD/SAS Trust Fund to provide funds to develop needed community services. In the final budget, $47.5 million was committed to the Trust Fund. Dorothea Dix Hospital and Whitaker School will remain open. In addition $200,000 was included in the budget to develop Assertive Community Treatment Teams.