Until 2012, Illinois used a clear and inhumane approach towards mental health treatment: institutionalize people at unprecedented rates, and slash funding for long-term treatment solutions. This 20th Century method may finally change in the coming months, thanks to three successful law suits against Illinois that has led to the closing of approximately half of their mental health clinics. But before I delve into recent developments, a bit of background ...
Given a D grade by the National Alliance on Mental Illness, Illinois has long been a terrible place to have a mental illness. The state has spurned funding for the non-profit sectior, making $114 million in mental health cuts between 2009 and 2011, in favor of the lucrative practice of high-volume institutionalization. Until 2012, no state had more mentally ill people in nurseries and IMD's (Institutions for Mental Disease) than Illinois. These facilities - some state-owned and others privately-owned - have made huge profits by warehousing people on Medicaid and Social Security. They bill Medicaid for virtually every service they provide, while simultaneously siphoning their tenants' SSI through rent payments. It's no coincidence that these facilities typically charge around $660 a month. Most of their tenants have one source of income: a $690 monthly SSI check. After rent, they are left with about $30 in discretionary income - barely enough for a cab ride, let alone a security deposit. In other words, these facilities turn tenants into prisoners so that they can continue billing Medicaid and funneling social security income for years and often decades. These facilities generally lack education or rehabilitation services, giving their tenants little hope for recovery or personal advancement.
This practice of unwarranted institutionalization has long been considered discrimination under the Americans with Disabilities Act (Olmstead v. L.C. 52 U.S. 581). Way back in 1999, the Supreme Court court ruled that those who live in institutions have the right to live in the community if they and their treatment teams agree that they can - and want to - live in the community. States such as Illinois that weren’t in compliance with the ruling began to set up committees and task forces to study the situation and propose solutions. Yet, while many states put services in place to support independent living and limited the size of their group homes to six people, Illinois never enforced its procedure and the state continued to place its disabled citizens in nursing facilities and IMD's.
When letters from advocacy groups for the disabled to then Gov. Rod Blagojevich were ignored, the groups - which included Access Living, Equip for Equality, the ACLU of Illinois, SNR Denton, and the Law Offices of Steve Gold - filed three Olmstead class action lawsuits on behalf of specific individuals:
1. Ligas v. Maram, filed on behalf of 6,000 people with developmental disabilities who now live in large private facilities,
2. Colbert v. Quinn, filed on behalf of 20,000 people with disabilities in nursing homes in Cook County, and
3. Williams v. Blagojevich (Quinn), filed on behalf of 4,300 people with mental illness living in IMDs.
It took several years of litigation, but victories came in 2010 and 2011. For the approximately 30,000 individuals affected by these rulings, these settlements will give them the choice to live and participate in their own communities instead of being forced to live in state institutions. Under the agreement, a case worker will meet with each and every individual and determine the social services they need - i.e. housing, employment, and/or improved medication support - to help them achieve self-sufficiency. Some, like Nathaniel Allen, transitioned smoothly into permanent housing. But understandably, when working with such a high-needs population, the process of community reintegration usually involves more than finding an apartment and handing over the key. Many require a range of coordinated services; in some cases, collaboration between the local mental health provider, the housing provider, the primary care provider, and the psychiatrist is required. Myriad social services, already overstretched from years of budget cuts, are dealing with staggeringly high case loads. Thresholds, a mental health agency in Chicago, will be absorbing about 300 new members. Now more than ever, Illinois needs to build capacity in the human service sector. More budget cuts will simply lead to longer waiting lists for services, which in turn could have dire consequences for an extremely vulnerable population that can ill-afford to wait for services.