In the late 1990s, two women with developmental disabilities, Lois Curtis and Elaine Wilson, were living in the psychiatric unit of the Georgia Regional Hospital. Curtis had been diagnosed with schizophrenia and Wilson with a personality disorder. They both received treatment from the hospital, and after time requested discharge with the approval of the caregivers who had been working with them.
The goal was for Curtis and Wilson to move into a community-based program that would become a new part of their continuum of care, giving them access to a support network as well as regular medication, while also allowing them to contribute to and be a part of the larger community. But the discharge management fell apart and the release didn’t go through. Despite being voluntarily admitted the hospital, Curtis and Wilson were not able to leave. Finally, the two women filed a lawsuit under the Americans with Disabilities Act, which dictated that Curtis and Wilson had the right to receive care in “the most integrated setting appropriate,” and that, furthermore, their being institutionalized unnecessarily was in violation of the ADA.
Olmstead vs. L.C.
The case was first brought against the Georgia State Commissioner of Human Resource, Tommy Olmstead. But it soon escalated, being routed to the Supreme Court in 1999, under the name Olmstead vs. L.C. On June 22, 1999, the U.S. Supreme Court held that unjustified segregation of persons with disabilities constituted discrimination in violation of the ADA.
The court then laid out the basis of the Olmstead plan: It dictated that public entities – such as the Georgia Regional Hospital – must provide persons with disabilities community-based services or living options whenever those services are appropriate, the individuals don’t object and the situation can be reasonably accommodated, based on resources.
To explain the ruling, the court clarified the rationale behind its judgments: To institutionalize an individual who could reasonably handle and benefit from being in a community necessarily implies that that person is either incapable or unworthy of being part of that community. Furthermore, the court stated that isolation in an institution limits the day-to-day lifestyle of an individual, whether that means socialization, employment options, education, the right of economic independence and core cultural experience.
The lasting impact of the Olmstead decision
The Olmstead’s legal importance was relatively simple: It clarified exactly how states should comply with Title II of the ADA. Today, most states have Olmstead planning in place to ensure that same clarity for all public institutions.
But the impact of the Olmstead decision echoes further than that. As important as the legal ramifications are, it also created a change in how Americans perceived individuals with disabilities – especially those with mental illnesses.
The great stigma that mental illness carries is still prevalent in this country, but the Olmstead decision helped create both a legal and social groundwork for the discussion of what those with mental illness offer a community. The next step is continuing to refine the system of care that those patients who have reentered the community at large are under. And with advances in technology, such as mental health EHR software and improved discharge management, hard-working caregivers are more capable than ever.
Today’s electronic health records don’t just make doctors visits faster or keep medical information more secure – the technology offers greater patient involvement and coordinated care. As important as this is for all Americans, it’s impact in the behavioral healthcare community – where information may need to be shared between family, the justice department, state and local agencies, therapists and doctors – is significant. Alongside states’ Olmstead planning, the right coordinated care model has the potential to change lives.