Part 2: Olmstead v. LC

The Olmstead v. L.C. Supreme Court case, decided on June 22, 1999, completely changed the way we treat those with mental illnesses. To some, what happens next is a massive victory for the disability community. To others, it is a massive mistake that has led not only to more crime but also to the abuse and exploitation of many of these individuals.

The case centered around two women, Lois Curtis and Elaine Wilson, who were residents of Georgia. Both women had dual diagnoses: mental illness and developmental disabilities.  Lois had been in and out of institutions since childhood. By her late teens and early twenties, she expressed a strong desire to live in the community. Her doctors at the Georgia Regional Hospital at Atlanta agreed that community-based treatment was appropriate for her. However, despite these medical recommendations, she remained confined in the institution.  

Similar to Lois, Elaine also had a history of institutionalization due to her cognitive disabilities and other mental health conditions. She also sought release from the same Georgia institution and was deemed medically ready for community living by her treatment professionals. Yet, like Lois, she was kept institutionalized for several years beyond her medical clearance. Despite being medically cleared to live in less restrictive settings, they were kept in institutions due to a lack of community-based services or state policies.  

Lois Curtis, represented by the Atlanta Legal Aid Society, sued the State of Georgia, specifically Tommy Olmstead in his capacity as Commissioner of the Georgia Department of Human Resources. The lawsuit alleged that Georgia's failure to provide services in the most integrated setting violated Title II of the Americans with Disabilities Act (ADA).  

Title II of the ADA prohibits discrimination by public entities (like state governments) against "otherwise qualified individuals with disabilities." A key part of the ADA, and central to the Olmstead case, is its "integration mandate," which states that public entities must administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities. The Department of Justice's regulations implementing the ADA further clarified this, stating that "a public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities."  

The plaintiffs argued that their continued confinement in a segregated institutional setting, despite medical professionals determining that community placement was appropriate, constituted discrimination based on their disabilities. They contended that unnecessary institutionalization was a form of segregation, violating the ADA's integration mandate. They sought the right to live in the community with the necessary supports.  

The Supreme Court agreed. In their 6-3 decision, they made it clear that involuntary institutionalization is mostly illegal. The Court held that "Unnecessary institutionalization of persons with mental disabilities... is discrimination." The Court recognized that isolating individuals with disabilities from society perpetuated stereotypes and assumptions that they were "unfit for or unworthy of participating in community life."  

Though they acknowledged that states do not have an unlimited obligation to provide community services and are not required to fundamentally alter their programs or services. However, it placed the burden on the state to demonstrate that providing community-based services would constitute a "fundamental alteration" of its programs or an "undue burden" on its resources. Importantly, the Court rejected Georgia's general "lack of funding" defense, emphasizing that states must make reasonable efforts to transition individuals into community settings.  

Following Olmstead, the U.S. Department of Justice actively began investigating states and localities for non-compliance, filing lawsuits, and entering into settlement agreements to enforce the Olmstead mandate. This has led to the closure or downsizing of many institutions and the expansion of community-based programs.

Olmstead v. LC was also a major victory for the Independent Living Movement, reinforcing their core belief that people with disabilities have the right to self-determination and full participation in society.

Even before Olmstead, several court cases established basic rights for institutionalized people. For example, Donaldson v. O'Connor (1975) ruled that a non-dangerous individual could not be confined in an institution if they could survive safely in the community with the help of family or friends. Wyatt v. Stickney (1972) established a constitutional right to treatment for institutionalized individuals. These rulings made it more legally complex and expensive to maintain the old institutional model.  

This was different. This new case essentially killed asylums as we knew them. For many, leaving institutions meant regaining basic human rights, autonomy, and dignity. They could make choices about their lives, live with greater freedom, and participate in community life. For those who successfully transitioned with adequate community supports, deinstitutionalization led to a significantly improved quality of life, better health outcomes, and greater satisfaction.

The Revolving Door

However, for many others, this led to widespread suffering. This was the result of a critical failure of deinstitutionalization, that failure being the widespread lack of adequate community mental health services. Many individuals were discharged without sufficient housing, follow-up care, medication management, or social support. This led to a marked increase in homelessness, especially among those with severe mental illnesses and/or substance abuse disorders.

This resulted in what has since been called Revolving Door Syndrome. This refers to people who are frequently hospitalized for psychotic episodes related to either mental crises or drug use. Many of them are unhoused, so after they are treated, they are often sent back out to the street. Unless the individual has the presence of mind to ask for and/or accept help, this results in further episodes, which lead to further hospitalizations. Hence, a revolving door.

With the closure of psychiatric beds and insufficient community alternatives, prisons and jails effectively became the "new asylums." Law enforcement became the first responders to mental health crises, and individuals with mental illness (even those who were nonviolent) were often arrested for minor offenses (e.g., loitering, trespassing, disorderly conduct) related to their symptoms, leading to overrepresentation in the justice system.

While Olmstead and the broader deinstitutionalization movement were driven by noble intentions and led to immense improvements in the lives of many, the uneven and often insufficient implementation of community-based alternatives created significant new challenges.

As a result, many on the right, and even millions of leftists, began to support changing the way we do things…