WASHINGTON – The Justice Department today announced that it has entered into a comprehensive settlement agreement that will transform the state of Georgia’s mental health and developmental disability system and resolve a lawsuit the United States brought against the state. The lawsuit alleged unlawful segregation of individuals with mental illness and developmental disabilities in the state’s psychiatric hospitals in violation of the Americans with Disabilities Act (ADA) and the Supreme Court’s landmark decision in Olmstead v. L.C.
The U.S. District Court for the Northern District of Georgia will retain jurisdiction to enforce today’s settlement agreement, which supersedes a 2008 agreement between the state and the Office for Civil Rights of the U.S. Department of Health and Human Services (HHS) concerning Georgia’s provision of community services for individuals with mental illness and developmental disabilities. In light of today’s agreement and the progress the state has made in complying with an earlier agreement regarding the conditions in the psychiatric hospitals, the United States has agreed to withdraw its motions to enforce that earlier agreement.
More than a decade ago, in Olmstead v. L.C., the Supreme Court found that one of Georgia’s state hospitals was impermissibly segregating two individuals with disabilities in that hospital when they could have been served in more integrated settings. The Supreme Court ordered states to serve individuals with disabilities in the most integrated settings appropriate to their needs.
“The Olmstead decision strongly affirmed that people with disabilities have a right to live and receive services in the most integrated setting appropriate for them as individuals,” said Thomas E. Perez, Assistant Attorney General for Civil Rights. “Under this agreement, the state of Georgia will provide services in the community to hundreds of people with developmental disabilities and thousands of people with mental illness. The promises of the ADA and Olmstead will finally become a reality for individuals in Georgia with mental illness and developmental disabilities.”
“Georgia is the home of the Supreme Court’s Olmstead decision,” said Sally Quillian Yates, U.S. Attorney for the Northern District of Georgia. “With this agreement, the state begins to make good on Olmstead’s promise to end the inappropriate segregation of people with disabilities in state hospitals that set apart from the community.”
“The expansion of community living opportunities is critical to protecting the civil rights of individuals with disabilities under Olmstead, said Georgina Verdugo, Director of the Office for Civil Rights at HHS. “The specific requirements and timelines in this agreement will ensure that Georgians with mental illness and developmental disabilities have the services they need to live full lives in the community and achieve their goals.”
The Justice Department began its investigation in 2007, and found that preventable deaths, suicides and assaults occurred with alarming frequency in the state hospitals. In January 2009, the department entered into a settlement agreement with the state of Georgia regarding conditions in the hospitals. Further investigation found that the state also failed to serve individuals with mental illness and developmental disabilities in the most integrated setting appropriate to their needs, in violation of the ADA and the Olmstead decision. In January 2010, the department filed a freestanding complaint under the ADA and a motion for immediate relief seeking to protect individuals confined in the hospitals from continued segregation and from threats of harm to their lives, health and safety. The department subsequently entered into extensive settlement negotiations with Georgia, the Office for Civil Rights and local mental health advocates.
The agreement signed today resolves the ADA lawsuit. The agreement expands community mental health services so that Georgia can serve individuals with mental illness and developmental disabilities in the most integrated setting appropriate to those individuals’ needs. Under today’s agreement, over the next five years, Georgia will increase its assertive community treatment, intensive case management, case management, supported housing and supported employment programs to serve 9,000 individuals with mental illness in community settings. The agreement will also increase community crisis services to respond to and serve individuals in a mental health crisis without admission to a state hospital, including crisis services centers, crisis stabilization programs, mobile crisis and crisis apartments; create at least 1,000 Medicaid waivers to transition all individuals with developmental disabilities from the state hospitals to community settings; and increase crisis, respite, family and housing support services to serve individuals with developmental disabilities in community settings.
The Civil Rights Division enforces the ADA which authorizes the attorney general to investigate whether a state is serving individuals in the most integrated settings appropriate to their needs. Please visit www.justice.gov/crt to learn more about the Olmstead decision, the ADA and other laws enforced by the Justice Department’s Civil Rights Division.
The agreements in this case protecting the rights of individuals with mental illness and developmental disabilities in Georgia are due to the efforts of the following Special Litigation Section attorneys: Judy Preston, Acting Chief; Mary Bohan, Deputy Chief; Timothy Mygatt, Special Counsel; Robert Koch, Max Lapertosa, Richard Farano, Aaron Fleisher, Jeffrey Murray, Jennifer Mondino, David Deutsch, Emily Gunston, Samantha Trepel, and Amin Aminfar, Trial Attorneys. In addition, the division received support and assistance from Aileen Bell-Hughes and Mina Rhee, Assistant U.S. Attorneys for the Northern District of Georgia.
REMARKS AS PREPARED FOR DELIVERY BY ASSISTANT ATTORNEY GENERAL FOR THE CIVIL RIGHTS DIVISION THOMAS E. PEREZ ON A CONFERENCE CALL REGARDING THE STATE OF GEORGIA’S MENTAL HEALTH AND DEVELOPMENTAL DISABILITY SYSTEM
Good afternoon, and thank you for joining us today. The purpose of this call is to inform you about a landmark settlement with the State of Georgia that will allow thousands of people with disabilities to receive services and support to live in their communities, rather than in institutions.
More than a decade ago, in the landmark Olmstead v. L.C. decision, the Supreme Court determined it was illegal to unnecessarily segregate in institutions people with disabilities who could appropriately receive services in community-based settings. The decision was hailed as the Brown v. Board of Education of the disability rights movement – a recognition that unnecessarily segregating people with disabilities in institutions can be just as destructive as segregating children in schools. The Court’s decision acknowledged that segregating individuals with disabilities in institutional settings deprives them of the opportunity to participate in their communities, interact with individuals who do not have disabilities and make their own day to day choices.
Unfortunately, in Georgia, where the Olmstead case originated, and in many other states, the promise of the decision has not been fully realized.
Today’s settlement will change that. It is the most comprehensive settlement that the Department has ever reached in an Olmstead case, and we will use it as a template for our enforcement efforts across the country.
The settlement was negotiated in good faith with state officials. I personally met with Governor Perdue in January of this year, and I applaud him and other state officials for their willingness to work with us to come up with solutions that would better serve individuals with disabilities and the state as a whole.
Under today’s agreement, Georgia will stop admitting individuals with developmental disabilities to its state-run hospitals by July 1, 2011, and will transition all individuals with developmental disabilities already living in the hospitals to community settings by July 1, 2015.
The state will provide support coordination services to ensure individuals will have access to the necessary medical, social, educational, transportation, housing, nutritional and other services.
In addition, also by July 1, 2015, Georgia has agreed to provide services in community settings for 9,000 individuals with mental illness who currently receive services in the state hospitals, are frequently readmitted to state hospitals, are frequently seen in emergency rooms, are chronically homeless or are being released from jails or prisons.
The agreement also requires the establishment of 24-hour crisis service centers, as well as mobile crisis teams to respond to individuals experiencing a crisis anywhere in the community.
Today’s agreement, as with all of our efforts to enforce Olmstead, is about freedom for people with disabilities. It is about fulfilling our legal and moral obligations to ensure that all individuals, regardless of their disability, can receive the services most appropriate to their needs.
It is also about economic self-interest – Georgia will save considerably when it is able to close state-run hospitals that are typically inefficient.
The average daily cost to house a person in the state hospital is at least $479, or $174,000 per year. This compares to $47,000, the average cost of providing an individual with developmental disabilities services in their home. In addition, the state has to pay for mental health services provided in an institutional setting entirely out of state funds, but is eligible for Medicaid matching funds for community mental health services.
In past decades there have been movements toward deinstitutionalization, but those movements have too often failed because of a lack of appropriate community supports.
This agreement takes into account the lessons learned in the past to ensure that as the state moves toward providing services in the community, those individuals being served will have access to all of the necessary support.
President Obama made clear his commitment to making the promise of Olmstead a reality when he announced last year the Year of Community Living. In the Civil Rights Division, as well as in our sister agencies, we are committed to carrying out this vision, and we will continue to pursue cases that ensure that promise is realized. We will continue to aggressively enforce the law, and we hope other states will follow Georgia’s example and work with us to protect the civil and constitutional rights of people with disabilities.
United States v. Georgia
Civil No. 1:10-CV-249-CAP
Settlement Agreement fact sheet
October 19, 2010
The Settlement Agreement resolves the Civil Rights Division’s complaint against the State of Georgia regarding the State’s failure to serve individuals with developmental disabilities and mental illness in the most integrated setting appropriate to those individuals’ needs. Under the Agreement:
• Georgia will cease all admissions of individuals with developmental disabilities to their State Hospitals by July 1, 2011
• Georgia will transition all individuals with developmental disabilities in the State Hospitals from the Hospitals to community settings by July 1, 2015
• Georgia will create 1150 home and community based waivers for individuals with developmental disabilities by July 1, 2015: 750 waivers to help transition individuals from the State Hospitals to community settings, and 400 waivers to help prevent the institutionalization of those individuals currently living in the community
• Georgia will serve those individuals receiving home and community based waivers under the Agreement in their own home or their family’s home consistent with each individual’s informed choice
• Georgia will provide those individuals receiving home and community based waivers under the Agreement with support coordination to assist them in gaining access to medical, social, education, transportation, housing, nutritional, and other needed services
• Georgia will provide family supports to 2350 families of individuals with developmental disabilities by July 1, 2015, to help those families continue to care for a family member with developmental disabilities at home
• Georgia will have six mobile crisis teams by July 1, 2012, to respond to individuals with developmental disabilities experiencing a crisis anywhere in the community
• Georgia will establish 12 crisis respite homes by July 1, 2014, to provide respite services to individuals with developmental disabilities and their families
• Georgia will serve in community settings by July 1, 2015, 9000 individuals with serious and persistent mental illness who currently are served in the State Hospitals, frequently readmitted to the State Hospitals, frequently seen in Emergency Rooms, chronically homeless, and/or being released from jails or prisons
• Georgia will have 22 Assertive Community Treatment (“ACT”) teams by July 1, 2013, that operate with fidelity to the Dartmouth ACT model
• Georgia will have eight Community Support Teams (“CST”) by July 1, 2014, that provide services to individuals in their own home and ensure that community resources needed for the individual to remain in the community are in place
• Georgia will have 14 Intensive Case Management teams by July 1, 2015, comprising 10 full-time case managers per team, that coordinate treatment and support services and assist individuals with accessing community resources
• Georgia will have 45 Case Management service providers by July 1, 2015, that coordinate treatment and support services and help maintain services and supports already in place
• Georgia will establish six Crisis Services Centers by July 1, 2015, to provide walk-in psychiatric and counseling services in a center that is clinically staffed 24 hours per day, 7 days per week, to receive individuals in crisis
• Georgia will establish three additional Crisis Stabilization Programs by July 1, 2014, to provide psychiatric stabilization and detoxification services in a community-based setting
• Georgia will fund 35 community-based psychiatric hospital beds in non-State community hospitals
• Georgia will operate a toll-free statewide telephone system for persons to access information about resources in the community to assist with a mental health crisis
• Georgia will have mental health mobile crisis teams to respond to individuals experiencing a crisis anywhere in the community in every county in the State by July 1, 2015
• Georgia will have 18 crisis apartments by July 1, 2015, to serve as an alternative to crisis stabilization programs and to psychiatric hospitalization
• Georgia will have the capacity by July 1, 2015, to provide supported housing to any of the 9000 individuals with serious and persistent mental illness served under the Agreement who need such support, with 50% of the supported housing units being provided in scattered-site housing where no more than 20% or two of the units,
whichever number is greater, are used to provide supported housing under this Agreement
• Georgia will provide by July 1, 2015, housing supports to 2000 individuals who are deemed ineligible for any other benefits
• Georgia will provide bridge funding to 540 individuals by July 1, 2014, to support a transition to supported housing during the time needed for those individuals to become eligible and a recipient of other supplemental income
• Georgia will provide supported employment to 550 individuals by July 1, 2015, in accordance with an evidence-based supported employment model
• Georgia will provide peer support services to individuals receiving ACT and CST services and, by July 1, 2014, to an additional 835 individuals
• Georgia will have one case manager and one transition specialist per State Hospital by July 1, 2012, to help coordinate the transition of individuals from State Hospitals to community settings
Implementation and Quality Assurance
• Georgia will begin performing by July 1, 2012, an annual network analysis to assess the availability in the community of supports and services for individuals with developmental disabilities and serious and persistent mental illness
• Georgia will institute a quality management system by July 1, 2012, to perform annual quality service reviews of the community services provided under the Agreement
• The Parties selected Elizabeth Jones to serve as an Independent Reviewer to assess the State’s compliance with the terms of the Agreement