Principles: Home and Community Services and Other Supports for People with Mental Health Disabilities
In Olmstead v. L.C., the United States Supreme Court held 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 people have the right to integration and participation in all aspects of community life.
The right to live in integrated community settings is a fundamental right of all people regardless of the severity of their disabilities.
- 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. Peer services are integral to recovery.
- State and county mental health agencies should guarantee the availability of stable, quality living arrangements, to ensure people discharged from a facility have a safe place to live. Services and supports, including service coordination and peer providers, should be available as long as necessary to meet each person’s needs.
- Mental health and other services and supports should be directed toward achievement of the most independent and productive life possible and available throughout the state to prevent dislocation of people from their home communities.
Policies and practices of state and local governmental agencies should support the right of all people to live, work, recreate, socialize and receive publicly supported, culturally competent services in the most integrated community settings appropriate.
- People should receive, on an ongoing basis, an individual, “client-centered” assessment in order to determine the least restrictive, most integrated setting appropriate for providing individualized services and supports. The assessment should determine the goals, capabilities, strengths, preferences, barriers, and concerns or problems of the person. It should reflect awareness of, and sensitivity to, the lifestyle and cultural background of the person. The person should direct the assessment process.
- Institutionalized residents able to live in the community with community-based services should be identified and provided with transition services, needed community-based services and due process to challenge continued institutionalization. Input into the planning and delivery process should be obtained from people who live in or used to live in institutions.
- State and county agencies should identify people living in segregated community settings who could live in less restrictive, more integrated settings.
- Planning for discharge to the community or to a less restrictive community setting should be done in accordance with state and federal requirements and professional standards consistent with the recovery vision or model.
- Services should be provided in a nondiscriminatory manner, and provide "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 assumptions about what a person can or cannot do.
- Voluntary outreach services should be provided, including home 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 living in the community. Such services should be provided in a manner that is culturally competent, and respectful of a person’s rights.
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.
- People with lived experience in the mental health system should be involved in all aspects of local and statewide planning, implementation, service delivery and evaluation processes, such as development, implementation and evaluation of county Mental Health Services Act (MHSA) plans and statewide processes for funding allocations to counties.
The provision of publicly funded programs and services should support self-determination and provide people with opportunities to choose community-based options.
- 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.
- 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 to live in safe and appropriate non-institutional community-based settings.
- Mental health funding including MHSA should be used for their intended purpose of increasing access to voluntary, client-centered services.
- Mental health funding including MHSA should be used to expand and strengthen community mental health services and eliminate unnecessary institutionalization. Such funding, including capital improvement funds, should be used to expand outpatient crisis services, housing, and similar outpatient and living arrangements 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.
- Mental health funding including MHSA should be used for new and innovative services as determined by stakeholders.
- Neither MHSA funds nor MHSA capital improvement funds should be used for remodeling or expansion of county jails or inpatient or institutional facilities.
- Mental health funding including MHSA should be used to expand availability of crisis services so need for acute care hospitalization is reduced.
- The state and counties should comply with the “non-supplanting” requirements of the MHSA. There should be full funding from non-MHSA funds for each category of mental health services previously funded as of the 2003/2004 fiscal year.
- Other 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 can live in appropriate non-institutional settings in communities of their choice.
- Creative ways of funding supportive housing should be developed and implemented. For successful community living, housing resources should be strengthened and enhanced. All options for utilizing state, federal, county and other funding should be explored to develop safe and affordable housing options.
Welfare and Institutions Code Section 5813.5(d). “Return to Main Document”
See National Consensus Statement on Mental Health Recovery at: http://www.power2u.org/downloads/SAMHSA%20Recovery%20Statement.pdf. “Return to Main Document”
See President’s New Freedom Commission Report. “Return to Main Document”
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