Justices Reject ‘Unnecessary Segregation’ of Mentally Disabled at State Hospitals

In a landmark victory for people with mental disabilities, the Supreme Court ruled Tuesday that patients in state mental hospitals have a right to leave these institutions and move to small, community homes whenever they and their doctors think they are ready to do so.

The “unnecessary segregation of persons with mental disabilities” is a form of discrimination outlawed by the Americans With Disabilities Act, the court said on a 6-3 vote.

Tuesday’s ruling does not mean that most patients in these hospitals will be leaving soon, or perhaps ever. For many psychiatric problems, a hospital is the best and most appropriate setting, the court said. During the 1970s, officials erred by closing too many facilities and sending troubled patients out into the streets with no care or supervision.

The focus of the decision was on those patients who could be cared for just as well in a community home rather than in a large institution.

Some advocates said the ruling means the end of the “Nurse Ratchet method,” referring to the dominating, steely-eyed villain in the fictional mental institution featured in the movie “One Flew Over the Cuckoo’s Nest.”

Before 1955, more than 500,000 patients were housed in mental hospitals across the nation. Once considered a progressive form of treatment, these hospitals were scorned as prisons for patients in recent decades. These days, only an estimated 75,000 beds remain in state facilities for those with mental impairments.

The court’s ruling Tuesday stemmed from a case in Georgia, where state officials maintained that they had the authority to decide which form of treatment was better, even when their own doctors preferred the community homes.

Their policy was challenged by two mentally retarded women, Lois Curtis and Elaine Wilson, who hoped to leave the Georgia Regional Hospital in Atlanta. Doctors at the facility agreed that they were ready to move to a community home but hospital officials balked.

“The institution was not for me,” Wilson said in a telephone interview. “All you do is eat and sleep.” After moving to a community home during the course of litigation, Wilson said that she became active in programs that taught her to cook and to care for herself.

A federal judge in Atlanta ruled for the two women, as did the U.S. Court of Appeals. Georgia’s director of human resources, Tommy Olmstead, appealed on states’ rights grounds.

For disability-rights activists, the case was hailed as the “Brown vs. Board of Education decision” for the disabled, a reference to the 1954 ruling that outlawed racial segregation in public schools.

In California, a coalition representing 24 groups statewide that help persons with disabilities called the ruling “a milestone for the independent-living movement.”

Justice Ruth Bader Ginsberg wrote the majority opinion in the case (Olmstead vs. L.C., 98-536). Chief Justice William H. Rehnquist and Justices Antonin Scalia and Clarence Thomas dissented.