High Court Considers Care of Mentally Ill

The Supreme Court took up a case Wednesday that some advocates for the mentally ill call their “Brown vs. Board of Education,” referring to the landmark 1954 decision that outlawed racial segregation in public schools.

This year they hope the high court will outlaw the “segregation” of those who are mentally ill in large state hospitals, at least in cases in which they could be cared for just as well in a community home.

Clinton administration lawyers, siding with these advocates, say “unjustified segregation of persons in institutions” is a form of bias prohibited by the Americans With Disabilities Act. Federal regulations say public institutions must provide services for disabled people in the “most integrated setting that is appropriate.”

Leaning One Way

During Wednesday’s oral argument, a majority of justices sounded as though they were leaning that way.

“If there is no medical reason for putting them there [in state institutions] . . . and locking them up,” it must be considered discrimination, Justice Stephen G. Breyer told a lawyer for the state of Georgia.

Tommy Olmstead, Georgia’s commissioner for human resources, maintains that since his office is providing care for thousands of mentally ill people, the state is free to choose hospitals or community homes.

However, he has been successfully sued by two mentally retarded women who had been locked in a large state hospital in Atlanta. The women said they wanted out of the institution and preferred a community home. Doctors agreed they were ready to leave.

Elaine Wilson, one of the two plaintiffs, said her life was revived when a judge ruled she could leave the state hospital.

“In the institution, you can’t do anything. Just eat and sleep,” she said in a telephone interview. “Now I’m going to day programs. I’m learning to cook and to handle money. The institution is just not for me.”

After World War II, state-run mental hospitals across the country had space for more than 550,000 patients. Since then, four-fifths have closed.

Advocates disagree somewhat over how many people will be affected by the court ruling in the case known as Olmstead vs. L. C. and E. W., 98-536. The justices cited figures showing that 76,000 mentally ill people are confined in state hospitals.

Support Lukewarm

Georgia’s states’ rights stand has not garnered wide support. Only nine states signed a brief backing Georgia. Many others, including California, had joined with Georgia last year in asking the court to review the issue.

However, California officials did not support Georgia this spring when the issue came up for argument. California law includes a pledge guaranteeing people with disabilities a “right to social interaction and participation in community activities.”

Although the justices sounded sympathetic to the plaintiffs’ view, several worried aloud that a ruling in their favor might prompt states to dump mental patients who need institutional care.

“Can you assure me this won’t lead to thousands of people being thrown out” of state hospitals? Breyer asked a lawyer for the mentally retarded women.

His question was left unanswered. The justices have until late June to write an opinion.