BACKGROUND

In Olmstead v. L.C., the United States Supreme Court held that, under the Americans with Disabilities Act (ADA), unjustified segregation of people with disabilities is a form of discrimination. The Court stated that unnecessary institutionalization “perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.” The Court also said, “confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.” These principles guide our legislative advocacy to ensure that people with mental health disabilities have the right to integration¹ and participation in all aspects of community life.

Principles

The right to live in integrated community settings is a fundamental right of all people regardless of the severity of their mental health disabilities or where they live in the State.

1. Community-based services should be consistent with the philosophy, principles and practices of the recovery vision or model, which California has adopted and implemented as a governing standard for the state’s mental health system. Under this approach, “recovery” is viewed as a journey of healing and transformation that empowers a person to realize his or her full potential and to live the most independent and productive life possible.
2. Access to mental health treatment, community-based services, and housing vary among California’s 58 counties. The State and counties should ensure that individuals are entitled to and can access the full array of services, regardless of their county of residence. These services should be comprehensive, seamless and transparent for those seeking them.
3. People with mental health disabilities should have the right to due process regarding provision of any and all mental health services -- including having information about services and benefits available in understandable format, notice of delays, denials or termination of services, and the right to grieve and appeal delays, denials or termination of services.

Policies, practices of and services provided by state and local governmental agencies should support the right of all people with mental health disabilities to live, work, recreate, socialize and receive publicly supported, culturally competent services in the most integrated community settings appropriate.

1. People with mental health disabilities should receive, on an ongoing basis, an individual, “client-centered” assessment and service plan in order to support recovery and life in the least restrictive, most integrated setting appropriate. The assessment should determine the goals, capabilities, strengths, preferences, barriers, and concerns or problems of the person and spell out the services necessary to support recovery. It should reflect awareness of, and sensitivity to, the lifestyle and cultural background of the person. The person should direct the assessment and development of the service plan.
2. Services should be provided in a nondiscriminatory manner with reasonable modifications to meet the needs of people so they do not remain unnecessarily institutionalized. Services should be based on individual needs and not on stereotypes or assumptions about what a person can or cannot do.
3. The full array of community-based services and supports, including care coordination, Full Service Partnerships, Assertive Community Treatment, peer support, supported housing, mobile and other crisis services, rehabilitative mental health services and employment and educational support, should be available to meet each person’s needs. Services should be provided in a timely manner, and for as long as necessary, to meet each person’s needs.
4. State and county mental health agencies should guarantee the availability of quality community-based services and housing to ensure that people discharged from facilities have the services and housing they need in place, to avoid needless cycling in and out of institutions.
5. Outreach and engagement services should be provided, including visits by mental health professionals, peer counselors, rights advocates and other qualified providers, for purposes of meeting the treatment, education, employment, and quality of life needs of people with mental health disabilities. Such services should be provided in a manner that is culturally competent, and respectful of a person’s rights.
6. Public reporting on services provided, the cost and outcomes of mental health services provided by both state and local agencies, should be transparent. Data should be collected on all services provided, gaps in services, the funding for and cost of each type of service, unspent dollars or reserves, and the outcome or effectiveness of services impacting the lives of individuals with mental health disabilities. Such information should be made available to the public on an up-to-date and regular basis. Better data will generate strategies to reduce the disparities of access and quality of care within the mental health system on the basis of race, ethnicity, gender identity and other protected classes.

State and local government entities, with full participation by people with disabilities, family members, disability advocates and disability organizations should develop comprehensive, effectively working plans to place people in integrated settings and prevent unnecessary institutionalization.

1. State and county agencies should identify people residing in segregated settings who could live in less restrictive, more integrated settings. Institutionalized residents able to live in the community with community-based services should be provided with transition services and needed community-based services in a timely manner, along with due process to challenge continued institutionalization.
2. Input into the planning, delivery and evaluation of mental health services should be obtained from people with lived experience, including those who reside in or used to reside in institutions, as well as stakeholders, family members, providers and advocates.

The provision of publicly funded programs and services should support self-determination and provide people with mental health disabilities opportunities to choose community-based options.

1. Peer services should be developed statewide. Peer services should include services to people in institutions to help identify services and supports needed to transition into the community and to support such transitions.
2. People should live and receive services in the least restrictive, most integrated setting appropriate to meet their needs and consistent with their choice. Services should support self-determination and provide opportunities to choose home and community-based options.

Governmental entities should allocate and apply for sufficient funding to ensure the availability of appropriate services and supports of high quality to enable people with mental health disabilities to live in safe and appropriate non-institutional, community-based settings.

1. Mental health funding, including state-county realignment dollars, Medi-Cal reimbursements, and funds allocated under the Mental Health Services Act (MHSA) should be used to increase access to voluntary, client-centered services.
2. All mental health funding, should be used to expand and strengthen community mental health services and eliminate unnecessary institutionalization, including cycling in and out of psychiatric facilities and jail. Such funding, including capital improvement funds, should be used to expand outpatient crisis services and housing that reduce the need for incarceration, inpatient or institutional care. Funds should be used to expand voluntary Children’s, Adult and Older Adult Systems of Care, which provide a broad array of services, supports, and housing to help people to live in the community.
3. Mental health funding should be used to fund programs that work, including best practices and housing first models.
4. MHSA funds should not be used for remodeling or expansion of county jails or inpatient or institutional facilities.
5. The state and counties should comply with the “non-supplanting” requirements of the MHSA.
6. Mental health funding should be used consistent with the principles of the Bronzan-McCorquodale Act, which governs California's mental health system. It states that people "[s]hould receive treatment and rehabilitation in the most appropriate and least restrictive environment, preferably in their own communities.” (WIC §5600.2(a)(4)).

The development of affordable, accessible community housing options should be increased to ensure that people with mental health disabilities have the right to live in appropriate non-institutional settings in communities of their choice.

1. Supported housing, necessary to avoid institutionalization and provide effective community-based mental health treatment, should be fully funded.
2. Housing options should embrace the “most integrated setting” concept, which includes subsidized apartments and scattered site housing rather than simply congregate living options.
3. People with mental health disabilities should be able to have housing options and exercise choice, include the type of housing, with whom they live, and other important aspects of safe, affordable housing.

¹Current regulations define “most integrated setting” as the setting that enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible.” 28 CRF pt. 35, App. A, p. 450. – (Return to main document)