The Olmstead Decision

For people with psychiatric disabilities, the U.S. Supreme Court’s 1999 Olmstead v. L.C. decision is a monumental desegregation order. In the same way that the 1954 Brown v. Board of Education decision called on states to stop segregating schools by race, the Olmstead decision calls upon the states to stop unnecessarily segregating people with disabilities while providing services. The Olmstead case began when two women, Lois Curtis and Elaine Wilson, living in Georgia institutions sued the state, saying that their doctors had determined that community-based treatment would be more appropriate but that they were unjustly required to stay in the institution since no opportunities for community treatment existed. They based their case on the Americans with Disabilities Act (ADA), which prohibits discrimination based on disability.

When the case reached the U.S. Supreme Court, it ruled in favor of the two women. The decision noted that “unjustified isolation” in institutions is a form of discrimination prohibited by the ADA. The Court ruled that a state is required to provide community-based treatment to a person if:

  1. it is appropriate;
  2. the person does not oppose it; and
  3. the state has the resources to provide it. The Court also noted that a state could defend a lawsuit by showing that it had a “comprehensive plan” for placing people in community-based treatment.

Unfortunately, changes following the case have not developed rapidly. Just as desegregation was slow in the wake of the Brown decision, many disability advocates believe that the community inclusion required by Olmstead is not advancing quickly enough. Many states have failed to develop plans that meet advocates’ approval, with most plans lacking the specific timelines and budgets needed to ensure community placements. It took a dedicated civil rights movement to end segregation, and it is up to people with psychiatric disabilities and mental health advocates to stay involved in the Olmstead planning process to ensure that the needs of people with psychiatric disabilities are being met.

In many cases, advocates play a role in educating the states about the types of community-based services and supports that meet people’s needs. Because the Olmstead ruling contains some exceptions, some advocates are involved in demonstrating that those exceptions do not apply in most cases. They argue that community-based care is appropriate even for people who have been institutionalized on a long-term basis, that people will seek community-based care if they are allowed to see and test their options, and that states can fund community-based care by shifting funding away from the use of expensive institutional care.

For more information about the Olmstead decision, see The Bazelon Center for Mental Health Law at