Deinstitutionalization

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Question: True or False?  Because of decisions such as Olmstead, people with disabilities are being forced to leave institutions even if they want to stay.

Answer:  False.  The Olmstead decision defines three conditions for community placement:

1) The person can handle or benefit from community placement.

2) The transfer is not opposed by the affected person.

3) Community placement can be reasonably accommodated (United States).

 

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Olmstead

Since the early 19th century, the primary form of care for people with disabilities in the U.S. has taken the form of the “institution” – a large mental hospital or state training school housing hundreds of patients (Encyclopedia of Disability History). These institutions were originally developed by reformers in the 1800s who hoped to improve living conditions for people with disabilities. The number of people in institutions continued to grow through most of the 20th century, reaching its peak in 1967, when nearly 194,650 Americans were housed in large state institutions and an additional 33,850 were housed in state psychiatric facilities (United States).

But beginning in the late 1960s, this trend began to reverse. For the most part, the shift was due to changing attitudes and perceptions surrounding disability. Scholars and psychiatrists like Erving Goffman and Thomas Szasz began publishing articles and books displaying the negative effects of institutionalization (Encyclopedia). The system came to be seen as corrosive to patients’ health and invasive of civil liberties. Public outrage was amplified as dehumanizing conditions, from patients being tied down to patients being left sitting in their own feces, began to be published in the media. The most well-known of these stories was Geraldo Rivera’s video report at the Willowbrook State School in Staten Island, New York – a report that gave a face to what were previously only written accounts.

These changing perceptions in effect sparked political battles over the fate of the institution. Politicians began to speak out against the current system. Robert F. Kennedy famously called the Willowbrook “a snake pit” after his visit there.

Concrete legal progress really began to be made as people who were institutionalized and their families filed lawsuits against institutions for abuse. The Wyatt, Willowbrook, and Pennhurst cases all helped push the cause further, focussing on specific conditions in institutions. The verdict from the Wyatt case reads, “to deprive any citizen of his or her liberty upon the altruistic theory that the confinement is for human therapeutic reasons and then to fail to provide adequate treatment violates the very fundamentals of due process” (Wyatt v. Stickney).

Verdicts like Wyatt served as a good start for the deinstitutionalization movement, but it was not until the Americans with Disabilities Act and the Olmstead case that deinstitutionalization got a truly firm legal footing. In 1990, Congress passed the Americans with Disabilities Act (ADA), which among other things, “prohibited discrimination in the provision of public services” (Encyclopedia). Though this was not initially applied to institutionalization, attorneys defending patients in institutions began to use it to their advantage. Their principal tenet was that institutionalizing someone who didn’t necessarily need to be institutionalized was indeed “discrimination in the provision of public services.”

The issue came to a head with the Olmstead case, filed in Georgia in 1995. It reached the Supreme Court by 1999. The case involved two psychiatric patients named L.C. and E.W. who were deemed fit by professionals to leave the Georgia Regional Hospital in Atlanta where they were held but were denied from doing so by the State of Georgia, who asserted that they were not required to place them in the community (Encyclopedia). In a split decision, the high court ruled in L.C. and E.W.’s favor. Justice Ruth Bader Ginsburg wrote, “We confront the question whether the proscription of discrimination may require placement of persons with mental disabilities in community settings rather than in institutions. The answer, we hold, is a qualified yes” (Olmstead v. L.C.).

With that, the court effectively decided that unjustified isolation should indeed be regarded as a form of discrimination. The three conditions for community placement were defined as the following:

1) The person can handle or benefit from community placement.

2) The transfer is not opposed by the affected person.

3) Community placement can be reasonably accommodated (United States).

The third of these conditions is what Ginsburg was referring to when she wrote “a qualified yes.” In the years following the decision, what “reasonably accommodated” means has become the crux of many political battles over deinstitutionalization. For this reason, many disability advocates still are not satisfied with the number of people who are currently housed in state run institutions in America. As of June 30, 2009, 33,900 people remained institutionalized, a far cry from the 194,000 in 1967 (United States). While states are moving away from institution-based services for people with disabilities, there is indeed still much progress to be made.

 

Sources

Olmstead v. L.C. (98-536) 527 U.S. 581 (1999).

Taylor, Steven J. “Insitutionalization.” The Encyclopedia of American Disability History. 2009. Print.

United States. National Council on Disability. Deinstitutionalization: Unfinished Business. Washington: 2012. Online.

Wyatt v. Stickney. 325 F.Supp. 781, 784 (M.D. Ala. 1971) (1972).