The US Department of Justice (DOJ) recently announced that conditions in Nebraska are in violation of the civil rights of residents with serious mental illnesses, due to these individuals being unnecessarily segregated into institutional settings.
This case has its origins in grievances voiced by Nebraskans who felt the state was improperly segregating mental health patients from the general population, contravening Title II of the Americans with Disabilities Act of 1990 (ADA) and the concurring 1999 US Supreme Court decision in the matter of Olmstead v. LC.
In the 20th century, US authorities began implementing policies designed to reduce the institutionalization of psychiatric patients. The aim was to transition these individuals from large psychiatric institutions to community-based care settings. However, the policy met with challenges, including sparse resources in community-based settings and concerns about homelessness, incarceration, and insufficient mental health care.
Under Title II of the ADA, it is prohibited for state and local governments to discriminate against people with disabilities by denying or altering their participation in public programs, services, and activities. In the Olmstead case, the Supreme Court adjudged that financial constraints could not justify noncompliance with ADA guidelines. In essence, these legal frameworks require public entities to provide services to individuals with disabilities in settings most suited to their needs.
The DOJ has found that instead of assisting individuals with severe mental health issues in finding employment, Nebraska has been relying on segregated day programs and assisted living facilities. Moreover, DOJ documents reveal Nebraska’s limited access to community-based services, subsequently hampering individuals with severe mental illnesses from living independently. The lack of services such as housing assistance, case management, and peer support has forced many patients who were previously self-sufficient to enter segregated settings.
In a statement, Assistant Attorney General Kristen Clarke of the DOJ’s Civil Rights Division underlined the importance of developing community-based settings, noting that funneling people with disabilities towards institutionalization and unemployment goes against offering them pathways towards independence and dignity.
In its response, the Nebraska Department of Health and Human Services (DHHS) averred that Governor James Pillen has prioritized mental health care since taking office in January 2023, and has collaborated with policymakers and stakeholders to enhance community care offerings related to housing and age-appropriate care.
There is still a lengthy road to travel, but these legal revelations and the subsequent conversation they have sparked may signal the start of mitigating long-standing issues and improving the future landscape for mental health care not only in Nebraska but across all of the United States.