The US Department of Justice determined that Nebraska is violating the civil rights of residents with serious mental illnesses by unnecessarily segregating them into institutional settings.
The case emerged from complaints by Nebraskans that the state was improperly subjecting mental health patients to segregation from general society, in violation of Title II of the Americans with Disabilities Act of 1990 (ADA) and the 1999 US Supreme Court decision Olmstead v. LC.
In the second half of the 20th century, amid burgeoning concerns about the qualities of life and fundamental freedoms of patients relegated to mental institutions, US authorities initiated policies aimed at curbing the institutionalization of psychiatric patients. These policies aimed to transition individuals with mental illnesses out of large psychiatric institutions and into community-based care settings. Ultimately, the policy faced challenges including insufficient community-based resources, leading to concerns about homelessness, incarceration, and inadequate mental health care for some individuals.
A product of this policy initiative, Title II of the ADA stipulates that state and local governments cannot discriminate against people with disabilities by denying their participation in programs, services, and activities offered to the general population, or offering them different programs. In Olmstead, the Supreme Court determined that financial constraints could not determine whether states comply with the ADA guidelines. Combined, the Title II of the ADA and Olmstead “require public entities to administer services to individuals with disabilities in the most integrated setting appropriate to the individuals’ needs,” the DOJ wrote Tuesday in a letter sent to Nebraska Governor James Pillen. Instead of helping individuals with serious mental health issues find jobs, the state relies on segregated day programs and assisted living facilities, the DOJ found.
According to DOJ documents, Nebraska has limited access to community-based services, thereby robbing individuals with serious mental illnesses from continuing to live independently. The letter to Pillen argued that many psychiatric patients who were previously able to live independently and work in the community have been forced into segregated settings due to the lack of services such as housing assistance, case management, and peer support. “For Nebraskans with [serious mental illness], a lack of access to community-based services, including crisis services, can trigger unnecessary admissions to hospitals or [assisted living facilities].”
The letter went on:
We have determined that Nebraska is violating Title II of the ADA by unnecessarily segregating people with serious mental illness in assisted living facilities and day program facilities. The State’s administration of behavioral health services places others at serious risk of such unnecessary segregation in those facilities. This letter describes the United States’ findings and the steps the State can take to remedy the ADA violations we identify below.
The DOJ suggested several reform initiatives, including expanding access to existing community-based support services; offering employment support to individuals struggling with serious mental illness; ensuring relevant services are accessible to those with mental illness; better coordinating behavioral health offerings; and identifying individuals currently living in institutional settings who may do well independently.
In a statement, Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said:
Far too often, people with mental health disabilities are institutionalized when they could succeed and thrive in the community. … It’s time to bring an end to the days of funneling people with disabilities down a dead-end road towards institutionalization and unemployment when they could succeed if provided pathways towards independence and dignity.
In response to the DOJ’s findings, the Nebraska Department of Health and Human Services (DHHS) stated Pillen has made mental healthcare a priority since taking offic in January 2023, asserting the governor has worked with policymakers and stakeholders to enhance community care offerings related to housing and age-appropriate care.
