Tuesday, April 27, 2010

Michigan mental health policy in conflict with rights?

In Michigan, our local Community Mental Health (CMH) agencies provide services to people with developmental disabilities according to state and federal mandates and under contract to the Michigan Department of Community Health (MDCH). In providing services, the state and local CMHs must honor and protect the rights of the individuals they serve.

Promoting integration and inclusion in community life is part of federal and state mandates, but the degree to which this occurs is always tempered by the needs and preferences of individuals with disabilities. In their zeal to promote inclusion, state administrators and some advocacy groups are promoting policies that appear to conflict with individual rights to appropriate services by eliminating or limiting the services and settings available to people with developmental disabilities. To these administrators and advocates, any specialized program that provides services in group settings to people with developmental disabilities is segregated and discriminatory, whether or not the people served consider these programs necessary and part of their community.

Of most concern, is the intent of the MDCH to reduce and eventually eliminate so-called legacy programs: group homes, day programs, sheltered workshops, and other "disability-only" programs.

Vision for All Individuals with Developmental Disabilities

A draft policy that comes from The Standards Group, a part of the Michigan Association of Community Mental Health Boards
(MACMHB), has been distributed and discussed at meetings with state officials and local CMHs. [The latest version of this comes from the DD PIT SUBGROUP dated 2/16/10 and was discussed at a recent conference of the MACMHB.] It is based more on an ideology and a philosophy of how things should be, rather than on official law or policy. It describes a vision for all people with DD, regardless of the severity of the person's disabilities, cognitive abilities, or medical or other issues affecting the individual.

According to the "vision", an acceptable activity for a person with DD to contribute to his or her community might be for the person to volunteer for Neighborhood Watch, but volunteering with a group of others with disabilities would not be an appropriate choice. Other unacceptable practices include living in a licensed group home, attending a day program, doing things in the community in groups rather than with a friend or two, and engaging in activities that the general population would not engage in on a regular basis. Rather than relying on already established legal mandates to improve the mental health system, this document is promoting an ideology and vision for the future that not all of us share.

Olmstead Misinterpreted

Another justification for eliminating specialized programs for people with developmental disabilities, is based on a misinterpretation of the Olmstead decision, a 1999 US Supreme Court decision that determined when care in an institution is unjustified and considered discrimination under the Americans with Disabilities Act. Olmstead is often used to justify closing all institutions and by extension community programs that are considered "institutional" in nature. In fact, the court opinion says the opposite:

“We emphasize that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings...Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it.” 119 S. Ct. 2176, 2187 (1999).

In determining when a person should be moved to community placement from an institution, the court applied a three-part test, including that the transfer to a less restrictive setting is not opposed by the affected individual.

The Olmstead decision reinforced the individual's right to choose. Extending that to choices made regarding community services and settings, there is no reason to believe that Olmstead restricts choices for "disability-only" programs. In addition, there has been no genuine legal challenge to the authority of guardians or conservators of adults with developmental disabilities to make decisions on behalf of the person according to state law.

The state continues on a path toward eliminating specialized services for people with developmental disabilities and undermining their rights mandated by federal and state law. It does so with little scrutiny from either the public or our legislature.

More information on Olmstead .

More on opposition to the state vision from the Holland Sentinel.

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