Supreme Court Nears "Defining Moment"

NAMI Seeks Middle Ground Between "Cruel And Harmful" Extremes For People With Mental Illnesses

Apr 20 1999

Arlington, VA - Tomorrow, the U.S. Supreme Court will hear oral arguments in the case of Olmstead v. L.C. and E.W. (No.98-536), in which the State of Georgia is appealing an 11th Circuit federal court of appeals decision that held the institutionalization of two women with mental illness and mental retardation to be discriminatory under the Americans With Disabilities Act (ADA). Lower courts have found that institutional placements are a violation of the law when treating professionals agree that the needs of specific individuals can be met in "more integrated" community settings.

"The Supreme Court is approaching a defining moment," said Laurie Flynn, executive director of the National Alliance for the Mentally Ill (NAMI), the nation's largest grassroots advocacy organization for people with mental illnesses, which along with the American Psychiatric Association (APA) has filed an amici curiae ("friends of the court") brief in support of the women. "This is the kind of case that comes only once in a generation and may influence the treatment of individuals with severe mental illnesses for many decades to come."

NAMI and the APA agree that institutionalization is discriminatory and in violation of the ADA unless medical professionals consider it necessary. "Living in a community setting is for most people essential to pursuit of a full range of life opportunities," the brief declares. At the same time, the two organizations are encouraging the Supreme Court to seek a middle ground in its interpretation of the law:

"An extreme position in either direction can be cruel and harmful to the individuals whose interests are at stake," the amici brief warns. "On the one hand, isolation from the community, when not justified by the individual's needs, is undoubtedly a serious deprivation for the individuals…On the other hand, relegation to the exposure of an insufficiently protective environment, when such protection is needed may be dangerous and destructive for the individual, as well as for society, in undercutting the objectives of the ADA. Sweeping global pronouncements are out of place."

NAMI and APA together note that the law allows Georgia to assert that provision of community services would "fundamentally alter" the nature of its mental health system. However, they have urged the Supreme Court not to accept such a defense without strong evidence and justification.

"The nature of the balance contemplated by Congress--between short-term costs and long-term saving, in a statute indisputably ambitious in its intended effect--is not a matter properly examined in the abstract," NAMI and APA argue. The brief notes that the cost of care or treatment in community settings may be less than or comparable to those in institutions. Although higher "fixed" costs per person may result for institutions as individuals are transferred into community settings, the organizations argue that states must take into account "the possibilities of consolidating facilities, sharing staffs, instituting mixed uses of facilities, and adopting other measures that might materially reduce the costs of change."

"Olmstead is about the reasonableness of a presumption to require integration," explained NAMI's legal director, Ron Honberg. "It is the equivalent of Brown v. Board of Education for people with mental illnesses. The Supreme Court does not need to rule in this instance whether necessary changes in services in Georgia require a fundamental alteration of the state's mental health system. The choice is not necessarily between institutionalization that is inappropriate on the one hand and complete deinstitutionalization on the other. We hope the Court will reject extremes."