The ACLU and Bazelon Center for Mental Health Law currently have a class action lawsuit against the State of Illinois (Williams vs. Blagojevich, filed Aug 2005). The entire complaint can be read here (download ‘Complaint’ .pdf). Though long, it is well-written and worth reading. They allege that the state, in violation of the Americans with Disabilities Act (and following the 1999 Supreme Court ruling in the Olmstead case), does not provide the least restrictive environment possible when providing care, treatment and services to the mentally ill in Illinois. That is, they accuse the state of warehousing the mentally ill in nursing homes. They allege that the state is either not allowing these patients access to less restrictive community based services and housing and/or are not providing adequate community based options in the first place. They paint a grim picture of IMDs (ie., Institutions for Mental Diseases); however, unlike the Tribune, they appropriately place responsibility for this problem where it belongs: on the State of Illinois. I have two comments on this lawsuit.
First, their complaint is well founded. I believe it is true that (a) Illinois provides inadequate community based services to the mentally ill, (b) as a consequence Illinois over utilizes nursing facilities and (c) that the quality of these facilities is generally poor. That said, I think the lawsuit itself underestimates the acuity of a significant segment of the mentally ill population. A quote from the lead attorney, “Many, if not all, of the persons at these facilities could be served in more integrated settings in the community.” I wish it were so. Though true that if more community based resources were available, many residents of IMDs might be able to transition to less institutional settings, these facilities have a very large number of people that could not function in any currently available community living program, regardless of the resources provided. There will always be a need for 24 hour, structured supervised institutional settings. To assume otherwise is dangerous. In fact, the very problem the Tribune has been highlighting is that, if anything, far too many of the residents in these facilities are too disturbed and dangerous to even be placed in IMDs. If this is so, it is hard to imagine what sort of community based living program would provide adequate supervision to ensure the safety of the patient and those around him. What is needed, clearly, is a continuum of care. As extended hospital stays to stabilize a patient have all but disappeared, highly structured, 24/7 supervised living is a critical component of such a continuum. The intensive supervision, care and treatment previously provided by hospitals have shifted to IMDs. The question is (a) how should these be utilized (ie., not inappropriately utilized), (b) who should be placed in them (and, when clinically appropriate, their discharge facilitated), (c) how can quality services, including treatment and rehabilitation, be assured, and (d) how can these facilities be integrated with less restrictive community based options as patients become more stable and independent.
Though the lawsuit seeks to remove as many patients as possible from facilities like Somerset, I doubt the attorneys would feel much satisfaction with the closing of Somerset Place. The problem is obvious. The lawsuit alleges, essentially, that the state is shirking its responsibility toward the mentally ill in Illinois. Closing Somerset merely highlights the intransigence of the problem while inflicting harm on potentially hundreds of people. That is, the state has not increased available community based services. How many Somerset residents will simply be shuffled to a new ‘warehouse?’ The lawsuit itself illustrates that the problem with Somerset is not unique but pervasive within the entire system. Of those who are sent to less restrictive placements, to what degree have they been adequately prepared? Are they simply being set up to fail? Where, exactly, will the dangerous residents that the Tribune feels should be evaluated as high risk be placed? The state is making a show of closing Somerset. Sadly, all they demonstrate is their utter disorganization and continued failure to coherently address the needs of this population. And in the process exhibit a disconcerting lack of concern for the lives they are affecting.
The disposition and outcome of each and every resident removed from Somerset needs to be carefully tracked and monitored. This will be the state’s report card. Out of the hands of the evil nursing home and into the arms of the state. From this, we will see where the problem really lies. Such information might be relevant to the on-going lawsuit. We will see.