(July 5, 2012) Among the dozens of workshops offered at NAMI’s 2012 convention in Seattle last week was one of particular interest to us: “The Supreme Court’s Olmstead Decision: Implications for Mental Health Systems Reform.”
The 1999 Olmstead decision by the U.S. Supreme Court determined that states, must make community mental health treatment available as an alternative to institutional treatment for certain patients who could be safely integrated into the community. Although the decision was explicit that it should not be read “to impel States to phase out institutions, placing patients in need of close care at risk,” the case has widely been used as a justification to do just that.
In the workshop, a Department of Justice (DOJ) official detailed the benefits of the 40 “enforcements” of the Olmstead decision now underway in 25 states, including Delaware, whose mental health director was also on the panel. While there has unquestionably been a need to remedy deplorable conditions in Delaware and elswhere, what went unmentioned in the DOJ presentation were the inevitable negative consequences of incomplete remedies.
The combination of DOJ enforcement and dire state fiscal issues has led to a radical reduction in the number of public psychiatric beds as hospital patients with severe mental illness are "transitioned" into communities that far too often are unprepared to serve their special needs. DOJ special counsel Allison Barkoff acknowledged that “mistakes” were made in “opening the doors of institutions without looking at alternatives in the community” but failed to describe the practical, unintended outcomes of a process that has left hundreds of thousands of people “reinstitutionalized” in jails, prisons and hospital emergency rooms.
These and other consequences are “implications” of mental health system “reform,” too, and they need attention if deplorable conditions are truly to be remedied and not merely shifted elsewhere.