For three years, Stanley has lived in her own apartment on Chicago’s South Side. She cooks her own meals, sees her family regularly and manages her bipolar disorder with the kind of stability that once felt impossible. Previously, her only option besides living on the street was a nursing home — a place she describes not as somewhere to heal, but somewhere to survive.
It was a place that didn’t feel safe, and where Stanley, whose last name is being withheld to protect her privacy, felt like the residents and employees were working against her and her recovery.
Stanley’s path to recovery and independence was made possible by the little-known Olmstead integration mandate, born from a 1999 Supreme Court ruling that found unjustified institutionalization of people with disabilities is discrimination. Since that decision, this principle has pushed states to treat people in their communities, rather than hide them in institutions.
As community mental health practitioners with more than 40 years of experience, we have witnessed how deinstitutionalization transformed care in Illinois and the lives of each individual given the opportunity to thrive and determine their own future.
It’s why Thresholds — which provides community-based behavioral health and supportive housing across the Chicago area — has helped thousands of people move out of nursing homes and psychiatric facilities, and into successful, supportive living situations.
Jan Wrightsell was the first person Thresholds helped move. After years in and out of hospitals for schizophrenia, depression and psychosis, she left a nursing home in 2010 for her own apartment in Hyde Park. She never thought she’d be able to live on her own, but thanks to the community-based support made possible through Olmstead-related settlements in Illinois, she returned to her community and started her recovery journey.
Sixteen years later, she’s a working artist and a longtime peer support facilitator who shares her story to help others find their way, too.
DOJ narrows view of law
Last month, the U.S. Department of Justice released a memo espousing a dramatically narrower interpretation of federal disability law. The DOJ concluded that the Americans with Disabilities Act and the Rehabilitation Act don’t actually obligate states to serve people with mental illness in the community — a much narrower interpretation than nearly every federal court has taken of Olmstead.
The memo doesn’t change the law or existing consent decrees, but it signals the DOJ may stop enforcing them, opening the door for states to roll back community-based care.
This is the difference between living in your own home with a say in your own life and being locked away. Supreme Court Justice Anthony Kennedy warned in his Olmstead concurrence in 1999 about the risk of pushing people out of care too fast and with too little support. That’s a legitimate concern that deserves real investment, but it’s not an excuse to abandon the commitment to community integration.
Institutional care is a part of the continuum of care for those with very high needs beyond a hospital inpatient stay. But that care must be focused on supporting the client’s recovery to become well enough to move back to the least restrictive environment possible.
Recent federal actions also reinforce longstanding misconceptions linking people experiencing homelessness and mental illness to crime, but they are far more likely to be victims of crime than to victimize others. Public policy should be guided by evidence and experience, not stigma or misconceptions.
Housing, paired with clinical support, works
What the evidence does support is what Thresholds has done for six decades: Pair stable housing with real clinical support. Our work is proven both clinically and financially. Most people we’ve helped move out of institutions have stayed out, and a housing voucher plus our highest level of community care costs taxpayers less than a nursing home placement.
This isn’t a choice between compassion and fiscal responsibility. The evidence demonstrates that community-based care advances both.
We understand the impulse behind these efforts. Cities are struggling visibly with homelessness and untreated mental illness, and institutions can look like a clean solution. They are not. People living with mental illness are not a problem to be managed out of view. They are our neighbors. Our family. Our co-workers. Our friends.
Stanley and Jan’s stability isn’t a fluke. They are the result of a system built, slowly and deliberately, on the idea that people with mental illness deserve to live in their communities, not apart from them. Congress and state leaders should reject the DOJ’s invitation to retreat from that promise.
We cannot go back to the dark days of unnecessary institutionalization, not when we know, and have proven, that there’s a better way.
Peggy Flaherty and Debra Howard-Frye are co-chief clinical officers at Thresholds, a nonprofit organization that provides housing, employment and recovery services for people with mental illness and substance use disorders in Illinois.