In the latest court victory for mental health advocates working to ensure that the Americans With Disabilities Act (ADA), is enforced, thousands of people with serious mental illness in Illinois may soon be able to move from institutional settings to community-based housing where they can also receive treatment. These mentally ill individuals are gaining this option under the terms of a March settlement of a lawsuit filed against the state for "inappropriately warehous[ing]" them in large nursing homes rather than in community facilities.

A settlement agreement filed in the federal district court in Chicago in mid-March will allow about 4,500 people with mental illness the option of leaving large nursing homes—known as "institutions for mental diseases" (IMDs)—and moving to community-based housing that would include treatment and other needed support. The proposed agreement, which still requires the approval of Judge William Hart, would settle a class-action lawsuit—Williams v. Quinn (originally filed as Williams v. Blagojevich)—brought five years ago by mental health advocates on behalf of residents with mental illness housed in the IMDs by the state of Illinois.

Mental health advocates have long campaigned for alternatives to the state's two dozen IMDs, saying that those facilities are too large and impersonal and operated in a manner that allows little opportunity for independent living and personal growth of the residents who are mentally ill. They have argued successfully in similar suits that such facilities violate the Supreme Court's interpretation of the ADA, which mandated that people with serious mental illness who qualify must be offered community-based, assisted-living alternatives to institutional care.

"With appropriate supports, people with mental illnesses can live and thrive independently in the community and disprove the myth that they are unable to live on their own." said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law, one of five groups that brought the case. Advocates describe such alternative housing as subsidized apartments or group homes that have on-site support staff or frequent visits from professionals who provide treatment for psychiatric illness as well as job and life-skills training.

In its 1999 decision in L.C. and E.W. v. Olmstead, the Supreme Court ruled that the unjustified isolation of individuals with disabilities away from their communities is a form of discrimination based on disability. Bazelon won a similar case in September 2009 when a federal judge ordered the state of New York to move 4,300 residents with mental illness out of the state's nursing homes and into community-based and treatment-supported housing (Psychiatric News, October 16, 2009).

The Illinois agreement dovetailed with the recent recommendations of the Illinois governor's Nursing Home Safety Task Force. That group examined the state's nursing-home system after a series of violent incidents linked to inadequate supervision and monitoring involving younger people with mental illness living together with elderly residents in state nursing homes. The task force's consensus was that many people with serious mental illness housed in nursing homes "would be better cared for in specially designed and monitored community residential settings."

The settlement agreement would set up a process to evaluate all of the more than 5,000 mentally ill residents in state-funded IMDs to see if they would benefit from the transition to community housing. For each resident approved for the move, professionals will develop an individualized transition plan. It is believed that as many as 4,500 IMD residents would qualify. The settlement calls for the evaluations and transfers to take place over the next five years.

In addition to honoring the Supreme Court's Olmstead decision, the move could benefit the cash-strapped state by moving qualified residents from state-funded facilities to community-based settings that qualify for federal assistance.

"Illinois's antiquated policy has been bad for the individuals and costly for the state," said Ed Mullen, managing attorney for community integration at Access Living.

He estimated that the state, which is facing a $4 billion deficit this year, could save more than $50 million over the next few years by transitioning residents with mental illness from IMDs into community-based settings.

Information on the case is posted at <www.bazelon.org/newsroom/archive/2006/4-26-06-Williams-v-Blagojevich.html>.