Unnecessary Institutionalization Prohibited: OLMSTEAD V. L. C. (98-536) 527 U.S. 581 (1999)

In Olmstead v. L.C., 527 U.S. 581 (1999), the Supreme Court turned treatment for individuals with special needs on its head. Justice Ginsburg, writing for the Court framed the issue presented as follows: “Specifically, we confront the question whether the proscription of discrimination may require placement of persons with mental disabilities in community settings rather than in institutions.” The Court answered this question with a qualified “yes.”

Two women with mental illnesses were confined to institutional treatment. They filed suit and the District Court held that “the State’s failure to place L. C. and E. W. in an appropriate community-based treatment program violated Title II of the ADA. See id., at 39a, 41a. In so ruling, the court rejected the State’s argument that inadequate funding, not discrimination against L. C. and E. W. “by reason of” their disabilities, accounted for their retention at GRH. Under Title II, the court concluded, “unnecessary institutional segregation of the disabled constitutes discrimination per se, which cannot be justified by a lack of funding.”

In the Eleventh Circuit, the Court rejected an absolute cost-based defense. It held: “a cost justification would fail “[u]nless the State can prove that requiring it to [expend additional funds in order to provide L. C. and E. W. with integrated services] would be so unreasonable given the demands of the State’s mental health budget that it would fundamentally alter the service [the State] provides.” Id., at 905. Because it appeared that the District Court had entirely ruled out a “lack of funding” justification, see App. to Pet. for Cert. 37a, the appeals court remanded, repeating that the District Court should consider, among other things, “whether the additional expenditures necessary to treat L. C. and E. W. in community-based care would be unreasonable given the demands of the State’s mental health budget.” 138 F.3d, at 905.7.”

Justice Ginsburg wrote:

Recognition that unjustified institutional isolation of persons with disabilities is a form of discrimination reflects two evident judgments. First, institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life. Cf. Allen v. Wright, 468 U.S. 737, 755 (1984) (“There can be no doubt that [stigmatizing injury often caused by racial discrimination] is one of the most serious consequences of discriminatory government action.”); Los Angeles Dept. of Water and Power v. Manhart, 435 U.S. 702, 707, n. 13 (1978) (“ ‘In forbidding employers to discriminate against individuals because of their sex, Congress intended to strike at the entire spectrum of disparate treatment of men and women resulting from sex stereotypes.’ ” (quoting Sprogis v. United Air Lines, Inc., 444 F.2d 1194, 1198 (CA7 1971)). Second, 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. See Brief for American Psychiatric Association et al. as Amici Curiae 20—22. Dissimilar treatment correspondingly exists in this key respect: In order to receive needed medical services, persons with mental disabilities must, because of those disabilities, relinquish participation in community life they could enjoy given reasonable accommodations, while persons without mental disabilities can receive the medical services they need without similar sacrifice. See Brief for United States as Amicus Curiae 6—7, 17.

The Court held that cost-based considerations are not irrelevant. If, for example, the State were to demonstrate that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings, and a waiting list that moved at a reasonable pace not controlled by the State’s endeavors to keep its institutions fully populated, the reasonable-modifications standard would be met. But States are required to provide community-based treatment for persons with mental disabilities when the State’s treatment professionals determine that such placement is appropriate, the affected persons do not oppose such treatment, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities.”