Protection and Advocacy for People with Disabilities, Inc., (P&A) and six individuals with disabilities have filed a class action lawsuit against the South Carolina Department of Mental Health (DMH) and its Commission alleging violations of the Americans with Disabilities Act (ADA). The complaint alleges that DMH has failed to develop community-based services for individuals with disabilities, so that they are unnecessarily segregated and isolated at G. Werber Bryan Psychiatric Hospital in Columbia. The advocates call on the Defendants to develop sufficient community-based services to end unjustified institutionalization. One of the individual plaintiffs, known only as RC in the complaint, stated, "It just doesn't have to be this way."
Licensed for 530 beds and housing adults and children, Bryan Hospital is one of the largest hospitals in the state, and the largest psychiatric hospital in Georgia, North Carolina, and South Carolina. The average length of stay in some parts of the hospital may exceed 800 days. The complaint alleges that many of those days would not be necessary if the defendants provided adequate community services.
The failure to get patients out of the hospital to be more appropriately served through community-based services has a tremendous cost—both in terms of dollars and in terms of the effects unnecessarily long hospitalizations have on patients. "These long hospitalizations have a negative impact on the physical and mental health of the patients," said Gloria Prevost, Executive Director of the advocacy group bringing the lawsuit. "Time spent isolated, away from family and friends, leads to a physical and mental decline—the longer the residents live in this environment, the more disconnected they become from the community and any supports and resources that they had there."
In addition to the physical and mental harm to individual residents of Bryan, unnecessary institutional care is a significant financial burden to individuals and the state—the cost is $503 per day per patient. Sean Houseal, an attorney with the law firm Womble Carlyle Sandridge & Rice, LLP, which represents the plaintiffs pro bono, notes, "Defendants have not made adequate services available in the community as required by the ADA. The complaint alleges that this discrimination, based on disability, results in our clients being stuck at Bryan Hospital for much longer than they need to be. They are forced to remain in an expensive hospital when they could receive community services for a fraction of the cost."
Services for individuals with mental illness vary widely around the state. In Charleston County, where the lawsuit has been filed in federal court, the local mental health center operates a mobile crisis unit-- the only such unit in the state--providing services 24 hours a day, 365 days a year. In neighboring Georgetown County the only option for an "after hours" mental health crisis is to head to the emergency room. "Weekends and evenings are when you need help," says Prevost, who worked for many years in the mental health field around the country before coming to P&A. The lawsuit seeks to make proven, evidence-based mental health services, like mobile crisis services, available throughout South Carolina to avoid unnecessary, expensive institutionalization of individuals who can live in the community with appropriate supports.
At Bryan Hospital in Columbia, the residents who need these services in order to be discharged spend their time waiting. They have few choices for treatment, activities, or contact with the community. Some residents wait months or even years because of the shortage of community treatment. One of the plaintiffs, CM, who is now 26, came to Bryan at age 19. She realizes that her youth has been spent in the hospital, but she remains hopeful she will be discharged. She wants to learn to live more independently, to get a job, and to write poetry. CM asks to at least "get a chance," to prove herself and what she is capable of achieving.
Segregating individuals who could safely live in the community is a form of discrimination under the ADA, as the United States Supreme Court ruled in the landmark decision of Olmstead v. L.C. Lois Curtis, L.C., brought the lawsuit to vindicate the rights of people with mental disabilities who were segregated in Georgia's state hospitals. The residents wanted to be discharged and their treating professionals agreed that, with services, they could safely live integrated in the community. The Court concluded, "Unjustified isolation . . . is properly regarded as discrimination based on disability."
As in the Olmstead case, the plaintiffs allege that discrimination through unjustified isolation continues in South Carolina at Bryan Hospital noting, "The culture of the asylum persists tenaciously." Advocates call upon DMH, through its Director and Commission (the Defendants), to end unjustified isolation by improving access to community mental health services.
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