Court refines law on disabilities

In one of three major rulings, court forces a shift out of hospitals

In a major victory for mentally disabled Americans, the US Supreme Court has ruled that mentally disabled residents of a Georgia state hospital have a right to receive their special state-funded programs and services outside hospital walls and fences.

In a 6-to-3 ruling, the high court said June 22 that the 1990 Americans with Disabilities Act (ADA) empowers mentally retarded residents of state mental hospitals to sue for immediate placement in community-based programs funded by the state.

The ruling will accelerate the trend - evident since the 1960s - of moving mentally retarded residents from state hospitals into community-based settings.

The justices said the failure of state mental-health officials to provide immediate placement in community-based programs amounted to a form of discrimination under the ADA. "States are required to provide community-based treatment for persons with mental disabilities when the state's treatment professionals determine that such placement is appropriate," writes Justice Ruth Bader Ginsburg for the majority.

But the court narrowed its decision by stating that judges assessing such cases must also take into account the resources available to the state.

Advocates for the mentally disabled hailed the ruling as a significant breakthrough in helping to fully integrate persons diagnosed with mental retardation into mainstream American life.

They argued that it was a form of illegal segregation to force mentally disabled persons into state mental hospitals as the only way to receive programs and services that could just as easily be offered in community settings.

"This case is critical to people with mental disabilities ... because it establishes the principle that they must be given services in the most intimate of possible settings," says Chai Feldblum, a law professor at Georgetown University here.

Georgia officials countered during arguments in the case that it should be left to the state to decide where publicly funded treatment programs will be located.

The case involves the plight of two women, Lois Curtis and Elaine Wilson, who were both diagnosed with mental disabilities and were longtime residents of a Georgia state mental hospital. The two women wanted to be placed in community-based programs for the mentally disabled, and their care professionals determined that they would both do better in such programs.

GEORGIA provides government-subsidized services for mentally disabled residents at state hospitals. Some services are also provided at the community-level. But these programs are not large enough to accommodate all in Georgia who qualify. So some are required to reside at state hospitals to receive the state services.

Ms. Curtis and Ms. Wilson sued Georgia under the ADA, claiming that the state was violating the federal civil-rights law by failing to transfer them to community-based programs.

Many state hospitals have a strong incentive to house the largest number of people possible in their institutions because each resident triggers additional federal funds, which provides jobs.

Studies show that mentally disabled persons progress more rapidly and have a better quality of life in community-based programs. Since the 1960s, the trend has been toward moving services for the disabled out of state hospitals and into the community. Some states have closed down their mental hospitals altogether.

But experts say some 60,000 mentally retarded individuals remain housed in such institutions. The ruling will escalate efforts to move as many of them as possible into community settings.

Advocates for the disabled argued it was a form of discrimination to force the disabled to enter state hospitals in order to receive services. The state said, rather than discriminating, it was attempting to allocate scarce resources to those most in need.

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