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Sanbourne v. Chiles

INTERESTS OF THE AMICI

The National Alliance for the Mentally Ill (NAMI) is a national, grass roots advocacy organization of families of persons with serious mental illness and persons with serious mental illness themselves. Composed of over one thousand local affiliates and 140,000 members, its goals are to advance treatment and services for persons with serious mental illness and to improve the quality of life for those who are affected by these illnesses. An important aspect of NAMI's mission is to advocate for improvements in public systems of care and treatment for individuals with serious mental illness.

The Florida Alliance for the Mentally Ill (FAMI) is a state affiliate of the National Alliance for the Mentally Ill. FAMI is composed of thirty-four affiliate organizations in the state of Florida, all of whom join in this amicus brief. FAMI has advocated for many years for improved services for persons with serious mental illness in Florida. Its membership includes families of persons who are current and former residents of South Florida State Hospital.

Amici file this brief in opposition to the proposed settlement in this matter.

STATEMENT OF THE CASE

This lawsuit originated in 1989 as Gonzales, Sanbourne, et al v. Martinez, Case 89-6283-CIV-NESBITT (Class Action Complaint For Injunctive And Declaratory Relief, 1989). The original complaint provided a detailed description of extreme neglect and non-existent services for the named plaintiffs. and for other patients at South Florida State Hospital (S.F.S.H.). Many of these individuals were long-term patients at the hospital and according to the complaint were receiving virtually no services while in the hospital designed to facilitate improvement towards eventual release into the community. Consequently, plaintiffs requested that the court "Declare unconstitutional and unlawful the failure of defendants to provide the class plaintiffs with humane care and adequate treatment necessary to ensure their liberty." Id at 39. Additionally, plaintiffs sought injunctive relief requiring defendants to inter alia "provide all class plaintiffs with humane care and adequate treatment as well as effective services in integrated community settings appropriate to individual needs consistent with accepted professional standards." Id at 40.

The issue of transitional services for class members in the community acquired a new urgency after the state, in June, 1993, recommended plans be developed for closing the hospital. This recommendation aroused considerable concern within South Florida among those who felt that the state would not be able to adequately address the needs of long-term hospital patients in the community. In September, 1993, lawyers for the parties filed a proposed "Stipulation For Settlement", the terms of which, they allege, "will completely resolve this litigation and meet the requirements of Rule 23(e) of the Federal Rules of Civil Procedure of reasonableness and fairness". Sanbourne v. Chiles, Case No. 89-6283-CIV-NESBITT, (Stipulation for Settlement, September, 1993), p.4.

Amici are filing this brief because they believe that the proposed settlement does not adequately provide for specific supportive services for class members, in accordance with their constitutional right to freedom from unnecessary restraints on their liberties. Although most of the class members are severely disabled and will require extensive services and long-term supports to reside in the community, the proposed settlement does not require the state to provide those ongoing services. Moreover, although there have been some improvements in conditions and services at South Florida Hospital, additional improvements and services are needed and the proposed settlement is unclear as to what will be required of the state in this regard.

It is the contention of amici that the proposed settlement is neither constitutional nor in compliance with fairness requirements under Rule 23(e) of the Federal Rules of Civil Procedure governing settlements in class action lawsuits. Most importantly, amici believe that the proposed settlement is not likely to provide long-term benefits for the class members. It leaves them in no better position than they are already in under Florida law and does not adequately assert their rights under the Due Process Clause of the Fourteenth Amendment of the United States Constitution. Amici therefore urge the Court to reject the proposed settlement and to direct the parties to engage in further negotiations, with the active participation of mental health consumers, family members and other advocates, to reach a settlement which better provides for the long-term needs of class members.

I. THE PROPOSED SETTLEMENT DOES NOT ADEQUATELY PROTECT THE LIBERTY INTERESTS OF PLAINTIFFS AS REQUIRED UNDER ARTICLE XIV OF THE UNITED STATES CONSTITUTION.

A. Institutionalized Persons Have A Liberty Interest In Freedom From Abuse And Neglect And For Minimally Adequate Services:

In Youngberg v. Romeo, 457 U.S. 307, 102 S.Ct 2452 (1982), the Supreme Court of the United States held that the plaintiff was entitled under the Due Process Clause of the 14th Amendment of the U.S. Constitution to minimally adequate training necessary to protect his "liberty interest in safety and freedom from unreasonable restraints." Id, 102 S.Ct. 2452, 2461. In the context of that case, involving a plaintiff with profound mental retardation and a history of aggressive, self-injurious behaviors, the Court limited the State's obligation to appropriate training and habilitation to best enable the plaintiff to function within the institutional setting, free of bodily restraints. Id at 2642. However, the Youngberg Court expressly acknowledged that "minimally adequate training" could mean something different when applied to different circumstances and different plaintiffs. "In determining what is `reasonable' -- in this and in any case presenting a claim for training by a State -- we emphasize that courts must show deference to the judgement exercised by a qualified professional." Id at 2461.

B. The Liberty Interest Possessed By Previously Institutionalized Persons With Mental Illness In Freedom From Abuse And Neglect And Unnecessary Confinement Continues Even After Release From The Hospital.

There is broad agreement that previously institututionalized individuals with serious mental illness require extensive services and supports upon release to survive in the community. See, e.g. Grob, G., From Asylum To Community: Mental Health Policy In Modern America, Chapter 10 (1991); Torrey, E.F., Nowhere To Go: The Tragic Odyssey Of The Homeless Mentally Ill, 1988. Many experts further agree that the lack of adequate services and supports for previously institutionalized persons with serious mental illness has been a significant factor in the increase in homelessness across the nation. See e.g., Torrey, Supra at 6; Coates, R., A Street Is Not A Home: Solving America's Homeless Dilemma, Ch. 12, (1990). In the late 1980's into the early 1990's, the trend towards downsizing and closing state hospitals has continued. However, the services which those persons require to live adequately in the community have often not been available.

Among the arguments marshalled by states is that there is no constitutional "right to treatment" in the community. That is, an individual's liberty interest, as established in Youngberg, in unnecessary restraints on his/her freedom is extinguished as soon as that person is released from the hospital. This is apparently a premise relied upon by counsel for plaintiffs and defendants in developing the proposed Stipulation For Settlement. However, this premise is faulty.

Although the Supreme Court in Youngberg did not address the rights of previously-institutionalized mentally disabled persons in the community, several courts interpreted that decision as conditioning the right to minimally adequate training and habilitation on institutionalization. That is, once the person leaves the hospital, he/she no longer possesses that right. Society for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239 (2d Cir. 1984); Lelsz v. Kavanaugh, 807 F.2d 1243 (5th Cir. 1987).

In 1989, the Supreme Court of the United States held, in Deshaney v. Winnebago, 109 S.Ct. 998; 489 U.S. 189 (1989) that a state has no constitutional duty to protect a child from his father after receiving reports of possible abuse. Id at 998. The Court premised its holding on the fact that the state had never assumed control over the plaintiff, who was severely injured while in the custody of his father.

The Deshaney decision stands for the proposition that the state has no obligation to protect its citizens from harm which it has had no role in creating. "Nothing in the language of the Due Process Clause itself requires the State to protect the life, liberty, and property of its citizens against invasion by private actors. The Clause is phrased as a limitation on the State's power to act, not as a guarantee of certain minimal levels of safety and security." Id at 1003. However, the circumstances in this case are very different from those in Deshaney. In this case, the state has affirmatively assumed responsibility over the class members through long-term institutionalization at SFSH. Some class members have been institutionalized for more than twenty years. (See footnote 10, Infra). Under these circumstances, the Deshaney Court agree's that the state has a duty to protect class members from harm.

"When the state by the affirmative exercise of its power so restrains an individual's liberty that it renders him unable to care for himself, and at the same time fails to provide for his basic needs - e.g., food, clothing, shelter, medical care, and reasonable safety - it transgresses the substantive limits on state action set by the Eighth Amendment and the Due Process Clause. ... The affirmative duty to protect arises not from the state's knowledge of the individual's predicament or from its expression of intent to help him, but from the limitation which it has imposed on his freedom to act on his own behalf."

Id at 1006.

To clarify, when a state acts affirmatively to restrain an individual's liberty (e.g. through institutionalization), it has a constitutional duty to provide whatever services are necessary to protect that person's liberty interests in safety and freedom from unnecessary restraints, in accordance with professional judgement. And, if it is the judgement of treating professionals that the person is capable of functioning in the community with the provision of appropriate services and supports, continued institutionalization of that individual constitutes an unreasonable, unconstitutional restraint on his/her liberty. Therefore, the state has a duty, under the Due Process Clause of the 14th Amendment, to provide those services and supports which are necessary, in accordance with professional judgement, to enable the individual to function in the community. When individuals are deprived by the state of their freedom for long periods of time, as is the case here, a very special relationship between the state and those individuals is created, because of their total dependence on the state. To remove those persons from the confines of long-term institutionalization with inadequate supports to enable them to survive is not only unconstitutional, it is unconscionable.

The obligation of states to provide supportive services necessary to enable individuals to transition into the community was addressed in the Federal Fourth Circuit in Thomas S. By Brooks v. Flaherty, 902 F. 2d 250 (4th Cir. 1990).

"We believe that the state's duty to render the kind of treatment prescribed by Youngberg is not discharged by simply releasing a class member from the institution where he or she had been hospitalized. Otherwise the state could unilaterally avoid the obligations imposed by Youngberg ... and defeat the claims of class members by terminating their institutional care while the case was pending." Thomas S. By Brooks v. Flaherty, 902 F.2d 250,255 (4th Cir. 1990).

Id at 255.

Similarly, in Wyatt v. King, the Court cited the state's obligation to treat formerly institutionalized persons in the community in rejecting a motion by the state to vacate a standard in an existing consent decree providing for adequate transitional treatment and care for patients released after a period of involuntary confinement in a state institution.

"Standard 34 is not based on some generalized notion of community care -- of the state's general knowledge of its citizens' need for community care and treatment or its expressions of intent to meet this need -- but rather on the limitation the state itself has imposed on patients through involuntary institutionalization. Standard 34 merely embodies the residual obligation placed upon the state by the due process clause to provide those transitional services necessary for a patient to move from a condition of institutional dependence, brought about when the state took the patient into custody against his will, towards one in which he will have to exercise more social independence."

Wyatt et al. v. King, Civil Action 3195-N, (M.D.Alabama, Northern Division, January, 1993), (order denying motion for modification of consent decree). See also, Clark v. Cohen, 794 F. 2d 79, 96 (3rd Cir. 1986), Becker, J., concurring, ("involuntarily civilly committed persons have a right to treatment sufficient to develop their self-care skills to at least the level at which they would be if the persons had not been institutionalized").

C. The Proposed Settlement In Sanbourne Does Not Comply With Minimal Constitutional Standards Because It Fails To Adequately Protect The Interests Of Class Members In Freedom From Unnecessary Restraints On Their Liberty.

1. The "Substantial Risk Of Harm" Standard Proposed In The Stipulation For Settlement For Evaluating The Adequacy Of Discharge Plans Does Not Adequately Protect The Liberty Interests Of Plaintiffs

The proposed Stipulation For Settlement in Sanbourn determines that the standard of "substantial risk of harm" is the relevant constitutional standard for purposes of evaluating adequacy of discharge plans. Id, Section 10(d); Section 14(b). This, Amici believe, does not comply with the requirements set forth in Youngberg, Id. The Stipulation does not define "substantial risk of harm" nor does it provide any guidance to courts on how it is to be applied. Moreover, Amici are unaware of any other consent decrees or case precedents which have adopted "substantial risk of harm" as the relevant constitutional standard for evaluating adequacy of discharge plans. Therefore, we believe that this standard is too ambiguous to provide a meaningful basis for evaluating discharge plans, in accordance with the constitutionally protected interests of class members in freedom from unnecessary restraints on their liberties.

Conversely, the proper standard for evaluating discharge plans is whether these plans adequately provide minimally adequate treatment and supportive services, in accordance with professional judgement, necessary to enable class members to function in the community, free of inappropriate restraints on their liberty. The determination of the supportive services needed and the length of time these services must be provided should occur on a case by case basis. Although Youngberg does not require all class members to be released into the community, if it is determined that continued institutionalization is an unnecessary restraint on a class liberty, the state must provide appropriate treatment and supportive services for so long as is necessary for that individual to successfully function in the community. Thomas S. By Brooks v. Flaherty, Id at 253-254; Clark v. Cohen, 794 F.2d 79, 87 (3rd Cir. 1986).

The Youngberg Court also imposed standards for what is properly to be considered "professional judgement." Clearly, the determination of minimally adequate services must be made by qualified mental health professionals (psychiatrists, psychologists) and not by state administrators. Id at 2462, footnote 30. Moreover, these decisions must comport with acceptable professional standards. Id at 2462 ("Liability may properly be imposed only when the decision by the professional is such a substantial departure from accepted professional judgement, practice, or standards as to demonstrate that the person responsible actually did not base the decision on such a judgement"). See also Thomas S. v. Morrow, 781 F2d 367, 375 (4th Cir. 1986); Association for Retarded Citizens of North Dakota v. Olson, 561 F. Supp. 473 (1982).

2. The Thirty Day Limit Placed On Enforcing The Obligation Of The State To Provide Services Prescribed In Discharge Plans Is Inadequate To Enable Plaintiffs To Successfully Transition Into The Community.

Section X, Provision 28 (a) of the proposed stipulation for settlement in Sanbourne limits enforceability of implementation of discharge plans for a period of thirty days upon leave of absence from South Florida State Hospital. This provision is substantially at odds with accepted knowledge about the treatment and supportive service needs of long-term institutionalized patients upon release into the community. The provision potentially allows the state to withdraw all supports after thirty days. The withdrawal of such supports would almost inevitably result in the rehospitalization of many class members. For others, it would lead to homelessness, involvement with the criminal justice system, or undue suffering in the community, thereby infringing upon their constitutionally protected interests in freedom from unnecessary restraints upon their liberties.

The current population of patients at SFSH (all of whom are class members) are primarily long-term patients with severe mental illness. Some of these individuals have multiple severe disabilities. See Gonzales, Sanbourne et. al. v. Martinez, Civil Case 89-6283 (Class Action Complaint For Injunctive And Declaratory Relief) 4/10/89, (profile of individual named class members, p 11-26). All of these individuals require extensive supports over extended periods of time in order to function and survive outside of the hospital environment. As stated, the Stipulation For Settlement imposes no obligation for the state to provide these supportive services for the period of time needed. Because of this, Amici believe that the Stipulation For Settlement leaves class members, particularly those who are to be released into the community, in no better position than were in before this lawsuit was filed.

There are several existing consent decrees which are useful for ascertaining how other jurisdictions view the services required by institutionalized persons with severe mental illness to function safely and effectively in their communities. In 1988, a consent decree was entered in the case of Edward K., et al v. John White, Jr., et al, Civil Action No. 88-3358, (U.S. Dist. Court, E.D.Pa., 1988). This agreement addressed the pending closure of Philadelphia State Hospital ("Byberry State") and the services which former residents of that hospital would receive upon their release. Unlike the proposed settlement in Sanbourne, this agreement provided a non-exclusive list of services required by class members, including "a stable living arrangement, necessary medical services, financial aid, vocational/educational services, social supports and appropriate leisure and recreational activities". (Id at 3). It further described how the Commonwealth of Pennsylvania intended to coordinate services for class members. Id at 4-6. Finally, it established that class members "shall receive appropriate community-based services ........ for the total number of months they were residents in Philadelphia State Hospital." Id at 6, emphasis added. It is perhaps not surprising that the closure of Philadelphia State Hospital has been cited as a model for other states to follow, and at a savings for taxpayers in Pennsylvania. See e.g. Byberry Miracle: The Inside Story, Coalition for the Responsible Closing of Philadelphia State Hospital.

In Alabama, the consent decree which was entered into pursuant to the notorious Wyatt litigation similarly contains Standard 34 which obligates the state to provide class members with adequate transitional services following release from a state institution. Wyatt standard 34 reads as follows:

" The Mental Health Board and its agents have an affirmative duty to provide adequate transitional treatment and care for all patients released after a period of involuntary confinement. Transitional care and treatment possibilities include, but are not limited to, psychiatric day care, treatment in the home by a visiting therapist, nursing home or extended care, out-patient treatment, and treatment in the psychiatric ward of a general hospital."

Wyatt v. Stickney, 344 F. Supp. 373, 386.

As with the Philadelphia State Hospital consent decree, the Court in Wyatt recognized (and continue's to recognize) the importance of providing adequate transitional care and treatment to psychiatric patients released from state institutions. Unlike the former, the Wyatt decree contains no specific time criteria for the provision of those services but provides for "adequate transitional treatment and care". This, Amici believe, is the proper constitutional standard to apply in this case. The discharge plans developed for class members in Sanbourne should be enforceable for whatever period is necessary to provide individual class members with "adequate transitional treatment and care," in accordance with acceptable professional standards.

II. THE PROPOSED SETTLEMENT DOES NOT MEET THE FAIRNESS REQUIREMENTS UNDER RULE 23(e) OF THE FEDERAL RULES OF CIVIL PROCEDURE AND SHOULD THEREFORE NOT BE APPROVED.

Rule 23(e) of the Federal Rules of Civil Procedure requires court approval of all settlement proposals in class action lawsuits. Before approval, courts must determine that proposed settlements are fair, adequate and reasonable. Bennett v. Behring Corp., 737 F.2d 982, 986 (11th Cir. 1984). This rule was developed in recognition of the potential that proposed settlements in class actions may not always adequately incorporate the best interests of class members. Therefore, although there may be a strong preference for settlement as an alternative to litigation, courts must carefully scrutinize settlement proposals to ensure that they adequately take the interests of class members into account.

Among the factors which a court must consider in evaluating the fairness of a proposed settlement in a class action lawsuit is "the substance and amount of opposition to the settlement." Bennett v. Behring Corp, Id at 986. The proposed settlement in this case has engendered a large amount of opposition from class members, persons with serious mental illness in the community, family members, and many other groups (including governmental boards in the districts served by SFSH). These concerns relate both to the substance of the proposed settlement (as discussed above) and to the procedures utilized in reaching the settlement.

A. The Proposed Settlement Does Not Satisfy Fairness Requirements Because It Contains Serious Flaws Which Are Detrimental To The Future Well-Being Of Class Members.

As discussed earlier in this Brief, Amici believe that the "substantial risk of harm" standard proposed as the basis for reviewing the adequacy of discharge plans is inadequate and does not comply with minimal constitutional requirements. Amici similarly believe that the 30 day limit on enforceability of discharge plans is inconsistent with the "minimally adequate services" standard developed in Youngberg and reinforced in many cases which followed. Beyond these issues, Amici are concerned about other aspects of the proposed settlement as well. A discussion of some of these concerns is contained below.

1. The provisions concerning the rights of class members to request review of discharge plans and their rights to request binding arbitration are inadequate because the time period provided for class members to exercise these rights are too short. This is particularly true because individual class members within the hospital may not be fully aware of their legal rights at the time of discharge planning nor be aware of the significance of these procedures.

2. In Section 10(e), it is stated that "the parties acknowledge that there is a risk that any of the services in the discharge plan may become unavailable if review is sought." This language is troubling and very unclear. Does this mean that if a class member requests review (or arbitration) of her discharge plan and loses, she may be discharged even if particular services specified in the plan are no longer available? At a minimum, there should be a strong disclaimer stating that individuals will not be discharged if services specified in their discharge plan are not immediately available upon release.

3. In Section 12, it is stated that "conditions at SFSH may change based upon the need for ongoing repairs depending upon wear and tear of the buildings, facilities and equipment, etc., and due to personnel leaving the hospital as a result of the announcement of recommended closure and reductions in work force." Amici are concerned that inclusion of this language will allow defendants to fail to take the steps necessary to improve conditions and treatment for those remaining in the hospital. It is noteworthy also that while Exhibit F contains specific policy principles for providing "safe, humane and effective treatment and care for individuals residing at state facilities while continuously striving to reduce the amount of time of hospitalization", section 29 of the proposed settlement states that these policy principles are "aspirational ... and not directly enforceable by the Court..".

4. In Section VII, sub-section 15, it is stated that "Defendants agree to voluntarily develop an effective community based system of care and supports, based on the public policy principles attached as Exhibit A and incorporated herein." As with Exhibit F, Exhibit A is subsequently stated to be "aspirational ... and not directly enforceable by the Court...".

Based both on past and current history, there are reasons to be dubious that the State will voluntarily take the steps necessary to develop an adequate system of services and supports for class members who are released from SFSH. The state has a history of making promises to its citizens with serious mental illness which have not been kept. A national evaluation of state programs for persons with serious mental illness published in 1990 (attached as Exhibit One) contained the following about the Florida system.

"Unfortunately, this prescription for disaster is not merely a theoretical exercise; for people with mental illness in Florida, it is a reality. The state forever preaches admirable principles like continuity of care, rehabilitation, community-

based services --- but it has never put its muscle or its money behind these principles, so they remain nothing more than lip service. And despite periodic attempts at improvement, with a growing population Florida is slipping backwards fast.

There is currently a severe lack of community services for persons with severe mental illness in south Florida despite the existence of provisions in Florida law directing the Department of Health and Rehabilitative Services to "implement a continuity of care management system for the provision of mental health care, through the provision of client and case management, including clients referred from state treatment facilities to community mental health facilities." Ch. 394.4573, Florida Statutes. Moreover, the state has admitted in its 1993 adult state mental health plan, filed with the U.S. Center for Mental Health Services, that

$1,980,000,000 is needed to provide supportive services to Florida's mentally ill adults residing in the community. However, only $4,000,000 is currently available from all sources for those services. The districts served by SFSH comprise approximately one-third of the state's population. Therefore, there is an approximate shortfall of $500,000,000 to serve those individuals with serious mental illness who currently reside in the South Florida community. This projected shortfall does not take into account those members of the Sanbourne class who still reside in the hospital.

5. Section 38(b) of the proposed Stipulation For Settlement establishes the rights of the parties to modify certain sections and exhibits of the proposed Stipulation without seeking formal modification from the Court. The sections and exhibits so specified are very important and it is consequently the position of Amici that these should not be modified without the consent of the Court.

B. The Proposed Settlement Does Not Meet Fairness Requirements Because Class Members And Their Advocates Were Not Adequately Involved In The Negotiations Between The Parties.

Rule 23(e) of the Federal Rules of Civil Procedure require court approval of all dismissals or compromises in class actions. This illustrates recognition that the interests of class members can potentially be compromised in complex litigation with multiple parties. See generally Manual For Complex Litigation, Second, Section 30.4. The compromise of class members interests doesn't necessarily mean that the lawyers engaged in fraud or collusion. "As a practical matter, the dynamics of class action settlement may lead the negotiating parties - even those with the best of intentions - to regard the interests of class members too lightly. Under Rule 23(e), the court must assure that any eagerness by the litigants and attorneys to conclude the case without the rigor and cost of trial does not disadvantage class members. Manual for Complex Litigation, Section 30.41.

The requirement of vigilant court oversight is particularly important in cases such as this one, involving class members who are extremely vulnerable and whose best interests can potentially be easily compromised. The Court's must evaluate the proposed settlement with an eye towards ensuring that the best interests of class members who may not be competent to advocate for their own interests are protected. "In passing on settlements of class actions under Federal Rule of Civil Procedure 23 the court should not regard itself as an umpire in typical adversary litigation. It sits also as a guardian for class members who have not received a notice or who lack the intellectual or financial resources to press objections." Weinberger v. Kendrick, 698 F.2d 61, 69 (2d Cir. 1982).

In the Wyatt litigation in Alabama, the parties sought modification to several of the standards set forth in the original consent decree in 1972. Citing the apparent lack of support for the modifications among the state's mental health consumers and their advocates, the Court initially ordered the parties "to clarify or change the decrees where necessary and to submit additional evidence in support of the decrees." Wyatt v. King, civil action no. 3195-N, slip op. at 9 (N.D. Ala. May 2, 1991). The Court subsequently approved somewhat altered modifications to the original decree. Wyatt v. King, civil action no. 3195-N, memorandum opinion and order (May 14, 1992). In discussing its original rejection of the modifications, the Court explained:

"It became clear to the court that counsel for the plaintiff class had failed to take sufficient steps -- or, it appeared, any steps whatsoever -- to solicit comments from class members and their advocacy organizations during the development of the decrees. At the fairness hearing, counsel were unable to present any evidence that would indicate the support of class members for these revisions. On the contrary, the court heard from numerous mental health consumers and their advocacy organizations who expressed strong criticisms of the proposed modifications."

Id at 4.

The Court then went on to explain why it was now approving the modifications.

" most importantly, these decrees, unlike the earlier versions, now appear to have the support of a large segment of the mental health community. This is primarily due to the efforts of counsel for the plaintiff class and counsel for defendants to involve the state's primary and secondary consumers, consumer organizations, and advocacy groups ... in the revision of the decrees."

Id at 5.

In consideration of the widespread and universal criticism of the proposed settlement emanating from all segments of the advocacy community in Florida, including most importantly persons with serious mental illness and their families, Amici strongly believe that the proposed settlement should be rejected and the parties urged to recommence negotiations, this time with the meaningful involvement of primary and secondary consumers As discussed above, the objections of the advocacy community are not frivolous but are based on their knowledge of the deplorable state of community services for persons with mental illness which currently exists in South Florida, and their realization that the proposed settlement does nothing to compel the improvement of this system.

CONCLUSION

For the reasons stated above, the proposed Stipulation For Settlement should not be approved.

Respectfully Submitted

Ronald S. Honberg

National Alliance for the Mentally Ill

2101 Wilson Boulevard

Suite 302

Arlington, VA 22201

Counsel for Amici Curiae


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