Federal Study on College Mental Health Services Reveals Long Waiting Lists, Other Barriers

July 2017 - The research team of the National Council on Disability (NCD) – a U.S. federal agency that provides advice to the President, Congress, and other federal agencies – will release the results of a national study on the experiences of students with mental health disabilities on U.S. college campuses during a session at the national conference of the Association on Higher Education and Disability (AHEAD).

To understand challenges, best practices, and emerging trends of supporting students with mental health disabilities, NCD’s report, Mental Health on College Campuses: Investments, Accommodations Needed to Address Student Needs, relied upon interviews with students, social science researchers, mental health service providers, college administrators, college legal counsel, and advocates. It also targeted critical student subpopulations, including veterans, Greek life, athletes, graduate and international students, amongst others.

The Mental Health on College Campuses report is available on NCD’s website at https://ncd.gov/publications/2017/mental-health-college-campuses. Key findings include:

• Colleges are struggling to provide adequate mental health services and supports for students with mental health disabilities due largely to increased numbers of students with mental health challenges attending colleges and a lack of financial resources.
   
• Students with mental health disabilities are often placed on lengthy waiting lists for mental health services – sometimes waiting over a month. Many schools do not screen for emergencies when students seek help.
   
• Community colleges are the least equipped to deal with student mental health issues when compared with state colleges and universities, even though they statistically serve the most at-risk student populations.
   
• The U.S. Department of Education, Office of Civil Rights (OCR) has not provided guidance to colleges on how to respond to students that pose a threat to themselves.
   
• Multiple restrictions in the provision of federal and college financial aid negatively impact the ability of students with mental health disabilities to complete their postsecondary education.

About the National Council on Disability: First established as an advisory council within the Department of Education in 1978, NCD became an independent federal agency in 1984. In 1986, NCD recommended enactment of the Americans with Disabilities Act (ADA) and drafted the first version of the bill which was introduced in the House and Senate in 1988. Since enactment of the ADA in 1990, NCD has continued to play a leading role in crafting disability policy, and advising the President, Congress and other federal agencies on disability policy.
Source: National Council on Disability press release July 2017

Illinois Residents of State-Licensed Facilities Never Received Increase In Personnel Care Allowance

Advocates for developmentally disabled and mentally ill residents of state-licensed facilities fought for years to win an increase in the small monthly stipend those individuals are allowed to keep for their personal needs.

article by Mark Brown for the Chicago Sun-Times | November 13, 2017                                
They appeared to have prevailed in July with approval of a new state budget and an income tax increase to help pay for it.

Legislators set the new “personal needs allowance” at $60 a month, up from $50 for some individuals and $30 for others.

But more than four months later, some of the would-be recipients say they still aren’t receiving the modest increases owed them and haven’t received a good explanation for why not.

The failure to pay the increase appears to be affecting only residents of nursing homes that care for the mentally ill, not the developmentally disabled, according to the advocates.

Organizers with the community group ONE NorthSide say they have identified at least three long-term care facilities for mentally ill individuals in Chicago where residents say they are still waiting for their raise.

One of those is The Clayton Residential Home in Lincoln Park, where resident Larry Bender Jr. said administrators have put the blame on the state.

Bender said residents of The Clayton received the extra $30 in September, but not in October or November. And he said they are still looking for a retroactive increase for July and August.

The personal needs allowance is intended to be exactly that — the amount of money that individuals residing in certain state licensed facilities are allowed to keep from their Social Security disability checks — of about $735 monthly — to spend on their personal needs. The rest of that money goes directly to pay for their care.

Bender, 46, who has been diagnosed with schizoaffective disorder, said he needs the extra $30 to buy clothing or occasionally something to eat beyond the nursing home’s daily fare.

“Some nice bacon, scrambled eggs . . . a hamburger,” Bender told me wishfully, before mentioning personal hygiene products like soap, deodorant and toothpaste.

The personal needs allowance is basically the only money these folks get to spend in a month, said Sam Wickham, a community leader for ONE Northside’s mental health justice team.

“You need a birthday card, it comes out of that money,” she said.

Wickham, who suffers from severe depression and PTSD herself, said she has never lived in a nursing home-type setting but has been told by friends that the low personal needs allowance was one reason many of them turn to panhandling.

“It was dehumanizing to them,” Wickham said.

I could not get a return call from The Clayton, which I’m told is a decent enough place, so I don’t know where the fault lies.

More than 400 mentally ill individuals live at the three facilities that haven’t paid the increased allowance. Three other facilities surveyed by ONE Northside are paying the new higher amount.

The affected facilities are called Specialized Mental Health Rehabilitation Facilities, which is only worth mentioning because of the acronym, SMHRF, which is pronounced “smurfs” by those in the field.

In an August 29 memo, the Illinois Department of Human Services Director Felicia Norwood notified all the service providers for the developmentally disabled and mentally ill, including the smurfs, that the increase to $60 was effective July 1.

Advocates say they are concerned there appears to be no clear plan for facilities to come up with the back pay.

I realize that the developmentally disabled recipients of this allowance are generally a much more sympathetic group to the public than those suffering from mental illness. When I first went to bat on this subject, it was for their benefit.

But the mentally ill folks in these facilities have some seriously debilitating issues of their own, and they’ve waited long enough.
https://chicago.suntimes.com/chicago-politics/developmentally-disabled-mentally-ill-allowance-increase/

Motion to Enforce Filed in Class Action on Behalf of Mentally Ill Prisoners in Illinois

Lawyers request federal judge to order Ill. Dept. of Corrections to remedy numerous violations

CHICAGO, IL - Oct. 10, 2017 - Lawyers representing over 12,000 mentally ill prisoners filed a Motion to Enforce the federal settlement agreement in Rasho v. Baldwin. The Illinois Department of Corrections (IDOC) entered into the settlement agreement in 2015. Lawyers filed this motion after IDOC failed to remedy numerous findings of non-compliance by federally-appointed monitor, Pablo Stewart.

The monitor’s first annual report, issued in May of this year, characterized the psychiatric care provided by IDOC as “grossly insufficient,” “extremely poor in quality” and “oftentimes dangerous.” Specifically, the monitor found that IDOC’s psychiatric appointment backlog is in the thousands; treatment plans do not comply with the settlement agreement; mental health referrals are backlogged; and those in crisis and segregation continue to suffer without the treatment they need. Solitary confinement, itself detrimental to mental health, remains the norm for those most at risk for mental health breakdowns. When IDOC failed to address the monitor’s findings, he sent them a letter earlier this month declaring that psychiatric care in Illinois prisons is in “a state of emergency.”

“Our clients are suffering and are at risk of serious harm on a daily basis,” said Amanda Antholt, senior attorney at Equip for Equality and one of the attorneys representing the plaintiffs. “IDOC has failed to adequately address the violations identified by the monitor, so we need the court to step in.”

Henry is an example of the suffering mentally ill prisoners are experiencing at the hands of IDOC. After he attempted suicide while in prison, he spent most of the next three months placed on “crisis watch” in a bare cell without his clothing or property—sometimes without a mattress. During that time, a psychiatrist saw him only once and his treatment plan was never updated. Unsurprisingly, Henry’s mental health deteriorated under these conditions. His only interactions with mental health professionals were brief daily check-ins at his cell door. The notes from those checks reflect that Henry was increasingly incoherent, confused, and hallucinating. Henry would spread feces over the cell and himself because he believed it would ward off demons. Eventually this led to a disciplinary ticket, resulting in further loss of privileges.

This isolation and complete lack of mental health treatment is far from the aggressive treatment required for those in mental health crisis. Unfortunately, Henry is far from the only prisoner treated to such harsh conditions. In fact, 4,842 prisoners have been classified by IDOC as “seriously mentally ill.”

“We gave the IDOC time to propose how they would comply given the monitor’s findings and IDOC had no plan,” said Harold Hirshman, senior counsel, Dentons, and lead pro bono counsel in the case.

The Motion to Enforce seeks a judicial order:

• finding IDOC is out of compliance with the settlement agreement with respect to treatment plans, evaluations, medications, segregation and crisis treatment and transitions;
• finding IDOC’s failure to provide adequate and necessary mental health treatment violates the US Constitution’s prohibition against cruel and unusual punishment, as well as the Americans with Disabilities Act; and
• requiring IDOC to submit a detailed plan on how it will bring itself into compliance with the settlement agreement.

Alan Mills, executive director of the Uptown People’s Law Center, stated, “Over the last year, I have visited hundreds of prisoners with mental illness in ten different prisons. While I have been representing Illinois prisoners for 35 years, I had never seen such depraved indifference to people’s well-being. People locked in tiny cages 24 hours a day, suffering from everything from terrifying psychosis, to depression so deep they had retreated deep within their own minds. People crying out for the medicine they desperately need—month after month, with no response. One very severely mentally ill prisoner recently ate glass and cut herself; as punishment for her act of self harm she was  left  in her cell with the untreated wounds.”

Mills continued, “Our filing today seeks to finally bring an end to this wholly unnecessary suffering. IDOC needs to provide treatment to this severely ill population, or someone else must do it for them. As a civilized society, we cannot tolerate this level of abuse in our prisons.”

Click here to read the full Motion to Enforce. Plaintiffs are represented by Equip for Equality, Uptown People’s Law Center and the law firms of Dentons and Mayer Brown on a pro bono basis.

Rasho v. Baldwin, No. 1:07-CV-1298-HAB-JAG, Central District of Illinois.

###

About Equip for Equality:
Equip for Equality is a private, not-for-profit legal advocacy organization and is the federally mandated Protection & Advocacy System designated to safeguard the rights of people with physical and mental disabilities.

About  Uptown People’s Law Center:
Uptown People’s Law Center (UPLC) is a nonprofit legal services organization specializing in prisoners’ rights, Social Security disability, and tenants’ rights and eviction defense. UPLC currently has nine pending class action lawsuits regarding jail and prison conditions.

About  Dentons:
Dentons is the world’s largest law firm, delivering quality and value to clients around the globe. Dentons is a leader on the Acritas Global Elite Brand Index, a BTI Client Service 30 Award winner and recognized by prominent business and legal publications for its innovations in client service, including founding Nextlaw Labs and the Nextlaw Global Referral Network. Dentons’ polycentric approach and world-class talent challenge the status quo to advance client interests in the communities in which we live and work.

About  Mayer Brown:
Mayer Brown is one of the largest global law firms both by number of lawyers and revenue. The firm has lawyers in key business centers across the Americas, Asia and Europe. Mayer Brown serves many of the world’s largest companies and financial services organizations, including a significant proportion of the Fortune 100, FTSE 100, DAX and Hang Seng Index companies and most of the major investment banks. Mayer Brown provides legal services in areas such as Supreme Court and appellate; litigation; corporate and securities; finance; real estate; tax; intellectual property; government and global trade; restructuring, bankruptcy and insolvency; and environmental.

Source: press release

Man with Mental Disability Dies After Struggle with Police in Texas

A Texas man who died after a struggle with police had an intellectual disability, sickle cell anemia and suffered from nerve pain that caused his legs to lock up and kick, a family member said.

Associated Press | Sept. 29, 2017                                                                                                   
Stephen Gayle died Thursday night after Temple police officers who responded to a disturbance call tried to put him in handcuffs. A Temple Police Department spokeswoman said Friday that the Texas Department of Public Safety will investigate the death and that there's no indication the officers "acted outside the scope of their duties."

An autopsy has been ordered to determine the cause of death.

Temple officers responded to a disturbance complaint around 7:30 p.m. Thursday near an apartment complex. They encountered Gayle, believing he was responsible for the disturbance, and said he was uncooperative and appeared intoxicated, according to a police release. During a struggle, the officers tried to handcuff Gayle and put him inside a police car, police said.

The Temple Daily Telegram reports that Gayle's family and people who witnessed the incident are questioning the account police have given. Witnesses who spoke to the newspaper said the officers, who were white, used excessive force to arrest Gayle, who was black.

Some of the witnesses told the newspaper they saw an officer place a knee in the man's back and punch him in the face while he was on the ground.

According to the newspaper, Gayle's sister, Tiffany Nuckols, said he had an intellectual disability and sickle cell anemia. She also said he suffered from nerve pain in his legs that caused them to lock up and kick sometimes.

"My brother, he wouldn't hurt nobody," she said. "My brother was a good person."

Wanda Nichols, a church pastor who lives in the neighborhood, said she saw Gayle walking down the street and yelling before police arrived. She said she thought he was trying to get the attention of a child who was practicing football nearby.

Police have asked for witnesses to come forward with information they might have about the incident.

Temple has about 73,000 residents and is about 75 miles north of Austin.

copyright Associated Press

Federal Study on College Mental Health Services Reveals Long Waiting Lists, and Barriers Impeding Student Success

The research team of the National Council on Disability (NCD) – a U.S. federal agency that provides advice to the President, Congress, and other federal agencies – released the results of a national study on the experiences of students with mental health disabilities on U.S. college campuses during a session at the national conference of the Association on Higher Education and Disability (AHEAD).

To understand challenges, best practices, and emerging trends of supporting students with mental health disabilities, NCD’s report, Mental Health on College Campuses: Investments, Accommodations Needed to Address Student Needs, relied upon interviews with students, social science researchers, mental health service providers, college administrators, college legal counsel, and advocates. It also targeted critical student subpopulations, including veterans, Greek life, athletes, graduate and international students, amongst others.

The Mental Health on College Campuses report is available on NCD’s website at https://ncd.gov/publications/2017/mental-health-college-campuses. Key findings include:

• Colleges are struggling to provide adequate mental health services and supports for students with mental health disabilities due largely to increased numbers of students with mental health challenges attending colleges and a lack of financial resources.
   
• Students with mental health disabilities are often placed on lengthy waiting lists for mental health services – sometimes waiting over a month. Many schools do not screen for emergencies when students seek help.
   
• Community colleges are the least equipped to deal with student mental health issues when compared with state colleges and universities, even though they statistically serve the most at-risk student populations.
   
• The U.S. Department of Education, Office of Civil Rights (OCR) has not provided guidance to colleges on how to respond to students that pose a threat to themselves.
   
• Multiple restrictions in the provision of federal and college financial aid negatively impact the ability of students with mental health disabilities to complete their postsecondary education.

TO ARRANGE FOR AN INTERVIEW: Members of NCD’s research team and staff are available for interviews prior to and following the presentation at the AHEAD conference. Contact Anne Sommers at asommers@ncd.gov.

About the National Council on Disability: First established as an advisory council within the Department of Education in 1978, NCD became an independent federal agency in 1984. In 1986, NCD recommended enactment of the Americans with Disabilities Act (ADA) and drafted the first version of the bill which was introduced in the House and Senate in 1988. Since enactment of the ADA in 1990, NCD has continued to play a leading role in crafting disability policy, and advising the President, Congress and other federal agencies on disability policy.

PRESS RELEASE  July 21, 2017

PEOPLE LIVING WITH MENTAL DISABILITIES FACE SIGNIFICANT RENTAL HOUSING DISCRIMINATION, FEDS REPORT

WASHINGTON – Sept. 2017 - Persons living with mental illness, intellectual or other developmental disabilities continue to face significant housing discrimination in the rental housing market, according to a new pilot study released by the U.S. Department of Housing and Urban Development (HUD).

Rental Housing Discrimination on the Basis of Mental Disabilities: Results of Pilot Testing finds that when compared to people without mental disabilities, those persons who are living with mental disabilities receive fewer responses to their rental inquiries, are informed of fewer available units, and are less likely to be invited to contact the housing provider.  In addition, HUD’s study found that they are less likely to be invited to tour an available unit, are more likely to be steered to a different unit than the one advertised, and are treated differently depending on their type of disability.

The study also examined what happens when a person with a mental disability makes a request for a reasonable accommodation, finding that a large percentage of people with mental disabilities were given a negative response to their requests, ranging from outright denials to subtler barriers.

“Today’s study spotlights the types of discrimination people with mental disabilities experience when searching for housing,” said HUD Secretary Ben Carson. “The findings will not only inform our enforcement efforts, but enable us to identify and remove barriers for those who face housing discrimination. Though nearly 30 years have passed since the Fair Housing Act was expanded to protect individuals with disabilities, we still have work to do to ensure equitable housing opportunities for all.”

The study has significant importance for the future of paired testing for housing discrimination because it represents the first multicity housing discrimination study to utilize people with mental disabilities as testers. Research focused on two areas: the prevalence and kinds of discrimination facing people with mental disabilities seeking rental housing in the private market, and effective methodologies for testing for housing discrimination using people with mental disabilities as testers.

As a pilot study, it was conducted through e-mail and phone testing in nine small and mid-sized urban rental markets that mirror the distribution of the mental and developmental disability population across metropolitan statistical areas in the U.S., and with in-person testing in the two large rental markets, Chicago and Washington, DC. Testing was divided equally between mental illness and intellectual developmental disabilities, and a total of more than 1,000 matched pair tests (i.e. pairing and comparing testers with mental disabilities with testers who have no mental disabilities, known as control testers) were administered.

The pilot study revealed that individuals with mental disabilities seeking rental housing were: 

• Less likely to receive a response to their inquiry in e-mail testing (17.55 percent of people without disabilities received a response compared with 9.19 percent of people with mental illness and intellectual or developmental disability in email testing);
• Less likely to be told an advertised unit was available in in-person testing (5.94 percent of people without disabilities were told that the advertised unit was available compared with 0.99 percent of people with mental illness and intellectual or developmental disabilities in in-person testing);
• Less likely to be invited to contact the housing provider in e-mail testing (7.69 percent of people without disabilities were invited to contact the housing provider to see the unit compared with 0.00 percent of people with mental illness and intellectual or developmental disabilities in e-mail testing);
• Less likely to be invited to inspect the available unit in telephone testing (21.26 percent of people without disabilities were invited to inspect the unit compared with 16.47 percent of people with mental illness and intellectual or developmental disabilities in telephone testing);
• More likely to be encouraged to look at a different unit than the one advertised in telephone testing, a potential indicator of steering people with mental illness and intellectual or developmental disabilitiestoward specific buildings or areas within rental complexes; and
• Treated adversely at disparate rates depending on disability type, with higher rates of adverse treatment found for individuals with mental illness than for those with intellectual or developmental disabilities.

Additionally, the willingness of a housing provider to grant a request for an accommodation varied by mode of testing, with the rate of granting a request for a reasonable accommodation being significantly higher when the request was made by telephone compared to email.  However, regardless of the testing mode, a significant percentage of people with mental disability seeking reasonable accommodation were given a negative response to their request.  Moreover, when requests were made by phone, response rates differed by type of disability, revealing that a higher percentage of housing providers were willing to provide accommodations to people with intellectual or developmental disabilities (63.8 percent) than to people with mental illness (55.2 percent).

These results suggest that a broad-based initiative to educate housing providers about their fair housing rights and obligations could be helpful.  The study also suggests that housing, disability, and civil rights organizations should increase their efforts to educate persons with mental disabilities about their housing rights, how to recognize discrimination, and what actions they should take when facing possible discrimination.

HUD is also publishing four supplemental short papers that complement and further illustrate the complex issues surrounding both housing discrimination against people with mental disabilities and the involvement of people with mental disabilities in testing for housing discrimination.  The main pilot study and four supplemental papers can be found here.

The supplemental papers are:

• Systemic Literature Review of Research on Discrimination in Rental Housing on the Basis of Mental Disabilities.
• Getting into and Maintaining Housing in the Private Rental Market: Experiences of People with Mental Disabilities.
• Accessible & Participatory Methods for Involving People with Mental Disabilities in Housing Discrimination Testing.
• Rental Housing Access & Discrimination Experienced by People with Multiple Disabilities.

The majority of complaints filed with HUD and its partner agencies under the Fair Housing Act in Fiscal Year 2016 were on the basis of disability, with 4,908 complaints – or more than 58 percent of all fair housing complaints. HUD provides Fair Housing Assistance Program funding annually on a noncompetitive basis to state and local agencies that enforce fair housing laws substantially equivalent to the Fair Housing Act, in order for them to support a variety of fair housing administrative and enforcement activities.Through the Fair Housing Initiatives Program, HUD also provides funds to eligible organizations through competitive grants under initiatives designed to prevent or eliminate discriminatory housing practices and inform individuals of their rights and responsibilities under the Fair Housing Act.  

###

HUD's mission is to create strong, sustainable, inclusive communities and quality affordable homes for all.
More information about HUD and its programs is available on the Internet
at www.hud.gov and http://espanol.hud.gov.

SOURCE: HUD Press Release

Illinois Health Plans Frequently Deny Coverage of Mental Health, Addiction Care - 2017 Report

Despite ongoing mental health and addiction crises, Illinois treatment providers responding to a recent survey report frequent claims denials and other barriers to coverage, according to a new report released today by The Kennedy Forum Illinois, Illinois Psychiatric Society, Illinois Association for Behavioral Health, Illinois Association of Rehabilitation Facilities, the Community Behavioral Healthcare Association of Illinois, the Illinois Health and Hospital Association, and Health and Medicine Policy Research Group.
CHICAGO, ILLINOIS  SEPTEMBER 19, 2017
Despite ongoing mental health and addiction crises, Illinois treatment providers responding to a recent survey report frequent claims denials and other barriers to coverage, according to a new report released today by The Kennedy Forum Illinois, Illinois Psychiatric Society, Illinois Association for Behavioral Health, Illinois Association of Rehabilitation Facilities, the Community Behavioral Healthcare Association of Illinois, the Illinois Health and Hospital Association, and Health and Medicine Policy Research Group.

The 16-page report, which is available here, raises important questions about health plans’ coverage of mental health and addiction conditions. Further investigation is urgently needed to identify and remove barriers, and ensure that Illinois Medicaid managed care organizations (MCOs) and commercial insurance plans are in compliance with federal and state laws that require they cover mental illness and addiction care on par with care for other medical conditions.

Key report findings include:

• Upwards of 75 percent of responding providers reported that Medicaid MCOs sometimes/often/always denied coverage for inpatient treatment, partial hospitalization, intensive outpatient treatment, and medication-assisted treatment. Nearly half of responding providers reported commercial insurers at least sometimes denied inpatient treatment.
• More than 60 percent of responding providers reported that Medicaid MCOs sometimes/often/ always refused to cover the requested level of care and instead approved only a lower level of care, while 54 percent of responding providers reported commercial insurers did the same.
• With Medicaid MCOs, nearly 65 percent of responding providers reported that they were told often or always that networks were simply closed. Nearly half of responding providers were told this often or always with commercial plans. The result: with mental health and addiction care providers unable to join plan networks, patients have more difficulty accessing care, due to the narrow network. 
• More than 90 percent of responding providers report that both Medicaid MCOs and commercial plans have refused to provide requested medical necessity criteria, despite clear legal requirements that plans do so.

The organizations responsible for the report call for regulators, legislators, health plans, and providers to investigate what coverage barriers exist to coverage and work to remove them.

"This survey makes clear that Illinois must do more to remove barriers to coverage of mental health and addiction treatment,” said Kelly O’Brien, executive director of The Kennedy Forum Illinois, a leadership a mental health leadership initiative that seeks to eliminate stigma and change public policy. “Unless we make the promise of federal and state parity laws a reality, we will be unable to make the progress we need in ending Illinois' mental health and addiction crises that are ravaging our communities."

The report highlights evidence from around the country, where health plans have been found to not be in compliance with mental health and addiction parity laws that require most plans to cover mental health and addiction treatment on par with other medical conditions. Former Congressman Patrick Kennedy, founder of The Kennedy Forum nationally and author of the landmark federal Mental Health Parity and Addiction Equity Act of 2008, called on policymakers to work to end stigma and discrimination against people living with mental health and addiction challenges.

"The mental health and addiction coverage barriers reported by Illinois providers are giant red flags that elected officials must urgently address,” said Kennedy. “Illnesses of the brain should be treated no differently than any other type of medical condition. To combat our country's mental health and addiction crises, we must enforce our laws and end discrimination against people with mental health and addiction challenges."

In response to the report, State Representative Deb Conroy (D-Villa Park), chairwoman of the House Mental Health Committee, expressed concern and promised the Committee would hold hearings.

"The General Assembly must get to the bottom of these reported barriers to mental health and addiction coverage. The Mental Health Committee will be holding hearings in the coming months to find out what coverage barriers exist and how we can remove them. To address Illinois' ongoing mental health and addiction crises, all stakeholders must work together to dramatically increase access to treatment and to ensure that state and federal parity laws are being followed."

Based on the report’s findings, State Representative Steve Andersson (R-Geneva), member of the Mental Health Committee, filed a resolution urging action that is co-sponsored by Rep. Conroy, House Deputy Majority Leader State Representative Lou Lang (D-Skokie), and Assistant Majority Leader State Representative Sara Feigenholtz (D-Chicago).

“This report makes clear that barriers to coverage for mental health and addiction issues remain and need to be addressed so that all people get the benefits of the coverage to which they are entitled,” said Rep. Andersson. "That is why I've filed House Resolution 607 asking the Mental Health Committee to formulate a plan to remove barriers to mental health and addiction coverage and improve coverage parity."

Rep. Lang, author of Illinois’ Heroin Crisis Act and chair of the Subcommittee on Substance Abuse of the Mental Health Committee, called for the General Assembly to pass legislation that increases transparency on whether health plans are in compliance with state and federal parity laws.

"This survey raises numerous red flags about barriers to mental health and addiction coverage. Even though Illinois has a strong parity law on the books requiring health plans to cover mental health and addiction treatment on an equal basis with other types of medical care, there is little transparency on whether health plans are complying with the law,” said Rep. Lang. “That is why the General Assembly needs to pass legislation that increases transparency to ensure consumers can access the coverage they're entitled to."

The report offers recommendations for all stakeholders, including health plans, regulators, legislators, providers, and even consumers to remove barriers to mental health and addiction coverage. Consumers should contact the Illinois Attorney General’s office and Illinois Department of Insurance if they are having difficulty with their commercial insurance plans, and Medicaid MCO consumers should contact the Illinois Department of Healthcare and Family Services.

“This report raises important questions about whether consumers can access mental health and addiction insurance coverage when they need it,” said Illinois Attorney General Lisa Madigan. “My office is committed to holding insurance companies accountable to our state’s mental health parity laws. Anyone who has problems with their health insurance coverage should contact my Health Care Bureau for help at 1-877-305-5145.”

Jennifer Hammer, Director of The Illinois Department of Insurance (DOI), said, “The Illinois Department of Insurance strives to make Illinois families aware of the resources & coverage available to them. Families dealing with mental health issues and substance use disorder deserve support and understanding. Our goal is to ensure consumers learn their rights under state and federal law." DOI encourages Illinois residents to use DOI’s free Consumer Toolkit for Navigating Behavioral Health and Substance Use Disorder Care Through Your Health Insurance Plan or call DOI toll-free at 866-445-5346 for consumer assistance.

The organizations authoring the reports said they have sent copies of the report to all members of the Illinois General Assembly, Governor Bruce Rauner, Attorney General Lisa Madigan, Illinois Department of Insurance Director Jennifer Hammer and Department of Healthcare and Family Services Director Felicia Norwood, with the intention of sparking necessary conversation to remove barriers to mental health and addiction coverage and treatment.

Additional expert quotes in reaction to the report’s findings: Meryl Sosa, Executive Director, Illinois Psychiatric Society: "Psychiatrists across Illinois regularly see patients' health plans deny coverage of needed mental health and substance abuse disorder treatment. Plan networks are often very difficult for psychiatrists to join, and plans often don't even provide requested medical necessity criteria, as required by law. To improve patient outcomes, health plans, regulators, and legislators must urgently work to remove these barriers to treatment."

Marvin Lindsey, CEO, Community Behavioral Healthcare Association of Illinois: “Access to mental health and substance use disorder treatment is incredibly important for the health and well-being of Illinois. Any barriers to needed behavioral healthcare services harm communities, individuals and their families and must be completely eliminated."

Margie Schaps, Executive Director, Health and Medicine Policy Research Group: “Ensuring health plans cover mental health and addiction care on par with other types of medical conditions is critical to patients being able to access the care and treatment they need to stay healthy. Untreated mental health and substance use disorders drive higher rates of disease and mortality, and contribute significantly to high health care and other social costs.”

Janet Stover, President and CEO of IARF, the statewide association of community-based providers serving children and adults with intellectual/developmental disabilities, mental illnesses and substance use disorders: “Parity in health care is essential for all of us, and is especially important for individuals with serious mental illnesses and substance use disorders. Barriers to care are not only detrimental to the health and well-being of individuals we serve and support, but to the overall healthcare system as well. IARF looks forward to working with our partners in health and long-term care to eliminate these barriers, resolving issues raised in the report, and ensuring better health outcomes for those we serve and support."

Sara Moscato Howe, CEO of the Illinois Association for Behavioral Health: “Compliance with state and federal behavioral health parity laws must be a top priority for managed care organizations and commercial insurance alike. Compliance must be built on a solid foundation of rigorous, transparent, and comprehensive data analysis, which must be mandated by the Illinois General Assembly.”

Click here to view and download complimentary versions of The Kennedy Forum’s policy papers. For more information about The Kennedy Forum and other helpful resources addressing behavioral health and substance use disorders, please visit http://www.TheKennedyForum.org.

# # #
About The Kennedy Forum Founded in 2013 by former Congressman Patrick J. Kennedy (D-R.I.), The Kennedy Forum focuses on advancing evidence-based practices, policies, and programming in behavioral health. This is achieved through promoting public discourse in health and addiction issues, ensuring equal access for patients living with mental health and/or substance use disorders; and advancing prevention and treatment throughout the entire continuum of the healthcare delivery system. The Kennedy Forum’s collaborative partnerships help to foster greater provider accountability, integration and coordination, cutting-edge technologies, and brain fitness and health. The nonprofit organization publishes frequent issue briefs and is a repository of other educational resources on behavioral health parity issues. To learn more about The Kennedy Forum’s efforts to eradicate the stigma often associated with behavioral health, or to access related materials visit http://www.thekennedyforum.org, http://www.paritytrack.org, and http://www.parityregistry.org.

Source: PRWEB press release http://www.prweb.com/releases/2017/09/prweb14713424.htm

Lawsuit over Tennessee’s Treatment of People with Intellectual and Developmental Disabilities, Dismissed

NASHVILLE, TENN. - Sept. 9, 2017 - A judge on Friday dismissed a longstanding lawsuit over Tennessee’s treatment of people with intellectual and developmental disabilities, ending federal oversight of state programs.

Gov. Bill Haslam lauded the dismissal of the case by Judge Waverly Crenshaw of Federal District Court. Governor Haslam said Tennessee has “fundamentally changed the way we serve some of our most vulnerable citizens.”

The Justice Department and the People First of Tennessee sued over conditions at three state facilities: Clover Bottom Developmental Center in Nashville; Greene Valley Developmental Center in Greeneville; and Nat T. Winston Developmental Center in Bolivar. A separate lawsuit concerning the Arlington Developmental Center was dismissed in 2013.

All four developmental centers have since been closed, with the state directing thousands of people with intellectual and developmental disabilities to home- and community-based care.

The state closed the 90-year-old Clover Bottom Developmental Center late in 2015. At its peak in the 1960s, it housed 1,500 people.

That’s when Debra K. Payne, now the commissioner of the Department of Intellectual and Developmental Disabilities, first worked at the facility as a 14-year-old volunteer.

“To walk in the halls and to see countless people in the institutions lined up against the walls, nothing to do all day,” Ms. Payne said of her experience in 1968. “Staff were at a minimum at that time. They were desperately trying to feed people, keep them clean.

“That was the minimum of care then,” she said. “It is so different today.”

The Haslam administration estimates that it has cost the state more than $300 million to make the changes needed to bring the court supervision of disabilities programs in Tennessee to an end.

The Justice Department praised the cooperation of state officials and advocates in resolving the case.

“Together, we have pursued this case to enforce the important rights of people with disabilities and to treat these individuals with dignity,” John M. Gore, an assistant attorney general, said in a release.

New York Times article on Sept. 9, 2017

https://www.nytimes.com/2017/09/09/us/judge-dismisses-suit-on-care-of-the-disabled.html?mcubz=3&_r=0

Illinois’ Treatment of Mentally Ill Prisoners “Exceedingly Poor and Often Dangerous”

Federally-appointed court monitor exposes shocking problems within IDOC

CHICAGO, IL – The first annual report of a federally-appointed monitor regarding the Illinois Department of Corrections’ (IDOC) treatment of mentally ill prisoners was released to the public today. It confirms the complaints prisoners and their lawyers have made regarding the care provided to prisoners with mental illness. The 113-page report characterizes the psychiatric care as “grossly insufficient” and “extremely poor” in quality.

Shortcomings found by the monitor include:

• insufficient psychiatric staff
• problems with the continuation of medications upon entry into prison
• failure to follow up on powerful psychiatric medication and monitor side effects
• dangerous practices related to the use of medication—including prisoners receiving forced medications
• enormous backlogs in psychiatric evaluations
• a lack of necessary mental health treatment for prisoners in crisis cells
• deterioration of mentally ill prisoners in solitary confinement
• a lack of planning for the treatment of virtually all prisoners with a mental illness

When Illinois prisoners are suicidal, officials put them in “crisis watch”—a barren cell with no books, radio, TV, paper, or blankets. The prisoner is kept naked, except for a “suicide smock.” The light is on 24 hours a day while a guard watches through Plexiglas. Typically, prisoners are kept here until they claim they are no longer suicidal.

One seriously mentally ill woman at Logan Correctional Center, “Melinda,” continually finds ways to self-harm, including cutting her arms on razor wire on the prison yard fence. Prison doctors refuse to use anesthesia when stitching up her self-inflicted wounds. Most recently, “Melinda” broke a light bulb in her cell and ate it, then was denied proper medical care and written a ticket for destruction of state property. When acting out due to her mental illness, she was pepper sprayed, then charged for the cost of the pepper spray.

The author of the report, Pablo Stewart, MD, was federally appointed as the result of the settlement of Rasho v. Walker, a class action lawsuit brought by Uptown People’s Law Center, Equip for Equality, Mayer Brown, and Dentons on behalf of all prisoners with mental illness in Illinois. “I am well aware that such a major shift in addressing the needs of the mentally ill offenders for an institution as large as IDOC can take time. For issues such as suicide prevention, medication management, use of force, confidentiality, discipline and preventing mentally ill offenders from deteriorating while in segregation, however, the time is now,” Stewart said in the report.

The Illinois Department of Corrections is ahead of schedule with regard to some changes necessitated by the Rasho v. Walker settlement, including opening a desperately needed 44-bed mental health hospital in Elgin, and a dedicated mental health facility in Joliet. Once opened, the new units should help relieve some of the harm being inflicted on those prisoners with the most serious mental illnesses. However, even when these facilities open, thousands of prisoners with serious mental illnesses will still not be receiving the care they require and are entitled to under the Eighth Amendment of the US Constitution.

IDOC estimates there are 12,000 prisoners with mental illness in the system; however, many experts think the actual number is much higher.

“We send far too many people to prison who have serious mental illnesses. They need treatment, not prison,” said Alan Mills, Executive Director of Uptown People’s Law Center. “While IDOC has made some significant improvements in its treatment of people with mental illness due to the settlement, the changes are not nearly extensive enough to relieve the suffering of thousands of people in Illinois’ prisons who are being left to deteriorate without proper care.”

“With violations of the agreement out numbering the areas of compliance, our clients are being harmed. Class counsel have initiated the enforcement procedures of the settlement and we hope to see improvements soon,” said Amanda Antholt of Equip for Equality.

“Many important things have been accomplished, unfortunately much that was committed remains to be done,” said Harold Hirshman, senior counsel, Dentons, and lead pro bono counsel in the case.

###

About Uptown People’s Law Center:Uptown People’s Law Center (UPLC) is a nonprofit legal services organization specializing in prisoners’ rights, Social Security disability, and tenants’ rights and eviction defense. UPLC currently has seven pending class action lawsuits regarding jail and prison conditions.

About Equip for Equality:Equip for Equality is a private, not-for-profit legal advocacy organization and is the federally mandated Protection & Advocacy System designated to safeguard the rights of people with physical and mental disabilities.

About Dentons:Dentons is the world’s largest law firm, delivering quality and value to clients around the globe. Dentons is a leader on the Acritas Global Elite Brand Index, a BTI Client Service 30 Award winner and recognized by prominent business and legal publications for its innovations in client service, including founding Nextlaw Labs and the Nextlaw Global Referral Network. Dentons’ polycentric approach and world-class talent challenge the status quo to advance client interests in the communities in which we live and work.

About Mayer Brown:Mayer Brown is one of the largest global law firms both by number of lawyers and revenue. The firm has lawyers in key business centers across the Americas, Asia and Europe. Mayer Brown serves many of the world’s largest companies and financial services organizations, including a significant proportion of the Fortune 100, FTSE 100, DAX and Hang Seng Index companies and most of the major investment banks. Mayer Brown provides legal services in areas such as Supreme Court and appellate; litigation; corporate and securities; finance; real estate; tax; intellectual property; government and global trade; restructuring, bankruptcy and insolvency; and environmental.

Press Release Last updated: September 05, 2017

State of Massachusetts Seeks Changes After Abuse of Mentally Disabled Patient at Judge Rotenberg Center

Investigators say two employees beat, whipped and spat on a restrained patient.

article by Sean Philip Cotter for The Patriot Ledger | June 22, 2017                                                      
The state recommends that the Judge Rotenberg Educational Center take a hard look at its policies after two now-former employees were charged with assaulting a patient.

The Massachusetts Disabled Persons Protection Commission investigation into the matter substantiated the abuse claims, according to the investigation report obtained by The Patriot Ledger.

The two ex-employees are charged with striking a tied-down mentally ill man with a belt and their hands on multiple occasions, as well as spitting on him at a Randolph residence owned by the Canton-based center.

“That (the two employees) acted with so little regard to (the victim’s) dignity and his behavioral program for such a period of time suggests that staff is either insufficiently trained or supported to carry out complex treatment programs for individuals with disabilities,” the commission wrote in its report.

The investigators found that the two employees had been doing this from time to time for nearly a year, according to the report. The commission wrote that the length of time this went undetected was concerning.

″(The Rotenberg Center) should review and revise this system to ensure the best protection for students and staff,” the report states.

No one from the center returned a message seeking comment Thursday afternoon.

Emil DeRiggi, the deputy executive director of the commission, said that the recommendations in the report are non-binding, but facilities generally acquiesce to them.

“They are typically followed pretty closely by whoever the recommendations are made to,” he said on Thursday.

The commission says that the main goal of any investigation the commission does is to determine if there’s further harm possible to any victims, and how further harm can be prevented.

As is normal protocol, the commission sent the completed report to the state Department of Developmental Services, which is one of the licensing agencies for the Rotenberg center.

No one from that department could be reached for comment Thursday.

The two employees charged are Mohamed Tarawally, 36, of 200 Hancock St., apartment 33, Boston, and Claude S. Guerrier, 24, of 67 Weston St., Brockton. Rotenberg suspended and then fired the two men after the allegations surfaced. They are both due to be arraigned in Norfolk County Superior Court at 2 p.m. Friday on assault charges.

Police say that Tarawally threatened, punched and hit with a belt an adult male patient. Guerrier shoved the patient, threatened him and spat on him, according to police.

Randolph police wrote in their report that video surveillance in one resident’s room in the facility at 20 Country Club Drive showed that one or the other of the men, both working the overnight shift, had committed these crimes at various times in October and November.

The Judge Rotenberg Educational Center has been the center of controversy for years, mostly over its use of electrical shocks on some of its patients as behavior-modification therapy. The private center, which provides various educational and behavioral services, was using skin shocks on 55 of the center’s 235 patients as of 2014.

That year, the federal Food and Drug Administration recommended that the center stop using the shocks; the FDA became involved after years of complaints from disability-rights groups and even a U.N. report that the shocks are tantamount to torture. Rotenberg has settled lawsuits in the past regarding the use of electric shocks.
http://www.patriotledger.com/news/20170622/state-finds-abuse-seeks-changes-at-judge-rotenberg-center

What Does Stigma have to do with Mental Health and Disasters?

According to the World Health Organization, 44-70 percent of people that needed mental health interventions do not receive treatment in any given year. Former U.S. Surgeon General David Satcher said that stigma was perhaps the biggest barrier to people seeking mental health care. Stigma is a negative and often unfair projection of shame or judgment onto people in a particular circumstance. It occurs when people socially distance a group of “others” based on perceived negative stereotypes. People with mental illness can also self-stigmatize, which can lead to denial, unwillingness to seek treatment or poorer prognosis. Disasters create conditions that may foster or exacerbate stigma for people experiencing emotional distress or symptoms of mental illness.

Author: Sarah Alcala, Senior Management Analyst with Aveshka Inc
Although many other barriers prevent people from seeking mental health care - lack of access to mental health care professionals, cost, cultural barriers, lack of symptom recognition - stigma remains one of the most concerning and, perhaps, preventable of all the things that make it difficult for people to pursue mental health care. It is an important factor for disaster responders to be aware of.

Following a disaster, people with pre-existing mental health needs or people with newly existing needs because of the disaster might experience stigmatization. Disasters can create situations where people may not have access to their medication, routines, caregivers, or providers, exacerbating existing mental illness symptoms. Congregate settings, such as shelters, can lend themselves to points of stigmatization because people are under stress, at a heightened sense of fear or anxiety and are often surrounded by strangers. Additionally, traumatic experiences in a disaster can worsen symptoms in people with pre-existing mental health needs and lead to behavior that is disruptive or upsetting to others. This may result in prejudicial treatment by other survivors or to misconceptions on the part of responders about those in need of care or support.

Disaster survivors are not the only ones that may need mental health interventions following a disaster. First responders may also experience trauma and need some degree of mental health intervention after disasters, but are unlikely to seek it because of stigma. First responders may feel seeking emotional support is a sign of weakness or failing in their abilities. They may be concerned they will experience ridicule from peers, or be labeled mentally unfit if they talk about distressing symptoms they may be experiencing. This stigmatization of mental health issues and treatment creates barriers that must be broken down to ensure responders seek the care they need when they are struggling to cope.

So, what can we do to break the stigma? Emergency planners and responders can engage mental health professionals in disaster planning and make addressing mental health part of the health and medical response. In congregate settings, planners and responders should recognize that mental illness may play a role in some behavior and facilitate access to a mental health professional. If a mental health professional is not immediately available, ensure staff and volunteers have the training to refer people to appropriate resources.

Everyone, including you, can create a culture where mental illness is treated as manageable medical diagnosis by:

1. Educating yourself and others about metal health. Check out these websites for more information:
• MentalHealth.gov
• SAMHSA’s National Mental Health Anti-Stigma Campaign
• Psychological First Aid for Leaders
2. Seeing the person, not the illness;
3. Talking openly about mental health to family, friends, and colleagues, and;
4. Being empathetic and compassionate about people experiencing mental illness – don’t use words like “crazy” or “psycho”.

When we take steps to reduce stigma around mental illness, we create and encourage a supportive, respectful culture that promotes health.

Author: Sarah Alcala, Senior Management Analyst with Aveshka Inc. in support of the Division for At-Risk Individuals, Behavioral Health & Community Resilience and Rachel E. Kaul, LCSW, CTS, Senior Policy Analyst and Behavioral Health Team Lead, HHS Office of the Assistant Secretary for Preparedness and Response
Published Date: 5/30/2017 2:41:00 PM

source: U.S. Dept. of Health & Human Services

Estimated 7,000 Bodies of Mental Health Patients Buried on University of Mississippi Medical Center Campus.

In this 2013 UMMC photo, Forrest Follet from the Cobb Institute of Archaeology, Mississippi State University, removes the soil from the lids of the dozens of unmarked graves uncovered during construction on the UMMC campus.(Photo: Special to The Clarion-Ledger)

Article by Jerry Mitchell , for The Clarion-Ledger | May 6, 2017                                                        
They are former patients of the state’s first mental institution, called the Insane Asylum, built in 1855, and underground radar shows their coffins stretch across 20 acres of the UMMC campus, where officials have wanted to build.

But those officials have faced a steep cost — $3,000 to exhume and rebury each body, as much as $21 million total.

Now UMMC is studying the cheaper alternative of handling those exhumations in-house, at a cost of $400,000 a year for at least eight years. It also would create a memorial that would preserve the remains with a visitors’ center and a lab that could be used to study the remains as well as the remnants of clothing and coffins.

Dr. Ralph Didlake, who oversees UMMC’s Center for Bioethics and Medical Humanities, believes the lab would be the first of its kind in the nation — giving researchers insight into life in the asylum in the 1800s and early 1900s.

“It would be a unique resource for Mississippi,” said Molly Zuckerman, associate professor in Mississippi State University’s Department of Anthropology and Middle Eastern Cultures. “It would make Mississippi a national center on historical records relating to health in the pre-modern period, particularly those being institutionalized.”

Didlake, Zuckerman and others have formed the Asylum Hill Research Consortium, made up of anthropologists, archaeologists, historians and even an expert in dating the wood of the coffins.

It was the consortium that developed the memorial/visitors' center/lab plans.

“We have inherited these patients,” Didlake said. “We want to show them care and respectful management.”

Asylum's history
  

Mississippi’s first mental institution became a reality when reformer Dorothea Dix of Boston rallied support among Mississippi lawmakers to fund construction of the $175,000 asylum, completed in 1855 (photo).

Before the asylum, those suffering from mental illness were chained in jails and even attics, said Dr. Luke Lampton, chairman of the state Board of Health.

While the asylum provided a better place for patients, life remained harsh. Of the 1,376 patients admitted between 1855 and 1877, more than one in five died.

After the Civil War ended, the facility expanded to house 300 patients, and the area became known as “Asylum Hill,” a neighborhood that included houses, a school and Cade Chapel Missionary Baptist Church, a church for former slaves.

At its height, about 6,000 patients stayed at the asylum, and the facility provided many jobs to the area, which saw construction of a fertilizer factory, a Baptist orphanage and a sanatorium for those suffering from tuberculosis.

In 1935, Mississippi moved the asylum to the present location of the State Hospital at Whitfield.

Two decades later, construction began on the same hill for UMMC.

In 2013, UMMC officials discovered 66 coffins while constructing a road on the 164-acre campus.

When the university began work in 2014 on a parking garage east of the dental school, underground radar revealed 1,000 coffins. More radar work revealed at least 2,000 coffins total.

Didlake said current estimates put the number as high as 7,000.

The consortium is hoping grants can make it possible for other researchers to join the study, he said.

For More of the Article form The Clarion-Ledger >>

Former Police Officer Charged With Raping Woman with Mental Disability

Thomas K. Jackson | LaPorte County Sheriff's Dept.

A 51-year-old former police officer has been charged with raping a woman whose mental capacities were too diminished for her to consent to sexual activity, according to police in northwest Indiana.

Chicago Sun-Times article by Jeff Mayes | April 25, 2017    

Thomas K. Jackson of Trail Creek has been charged with four counts of rape, according to the LaPorte County sheriff’s and prosecutor’s offices.

In March, the Michigan City police chief asked the sheriff’s office to investigate Jackson, a Michigan City police officer.

The request followed accusations of “inappropriate sexual contact between Jackson and the adult daughter of a LaPorte County woman who was reported to have such diminished mental capabilities that she could not consent to such activity,” a statement from the sheriff’s office said.

Jackson resigned from the police department on March 14. On Monday, the sheriff’s office and prosecutors presented evidence to a judge, who issued a criminal arrest warrant for Jackson, police said.

At about 7:35 a.m. Tuesday, Jackson was spotted at a convenience store near Trail Creek (just east of Michigan City) and was taken into custody without incident by sheriff’s detective and the Michigan City Fugitive Apprehension Street Team, according to police.

He was taken to the LaPorte County Jail on the $25,000 cash only bond specified in the warrant.

http://chicago.suntimes.com/news/former-cop-charged-with-raping-woman-with-mental-disability/

Federal Judge Angered by New York Falling Short in Resettling Mentally Ill Adults

Four years ago, after more than a decade of litigation and negotiation, New York State officials agreed that the system of often dismal and dangerous adult homes was no place for the mentally ill.

article by MARC SANTORA for The New York Times | APRIL 14, 2017
They agreed to move as many as 4,000 mentally ill residents out of their apartments and into supportive housing, a hard-fought recognition that people with disabilities should have the opportunity to live independently and participate in all aspects of community life.

But as a July deadline nears, a federal judge has found that the state seems far from meeting its commitment: Fewer than 500 people have actually been moved into supportive housing from adult homes.

But what the judge, Nicholas G. Garaufis of the Eastern District of New York, found most troubling was that the state appeared to be working with the adult home industry to undermine the settlement.

“I will not allow the kind of political, legal activity that is going on in this case behind my back and behind the backs of the plaintiffs to continue,” Judge Garaufis said at a recent hearing. “If I sound dramatic, it is because it is dramatic. It’s about them. It’s about 4,000 people.”

The Department of Health had quietly reached an agreement with home operators in state court that would have short-circuited the execution of the federal settlement — without ever informing the federal court.

“There’s some sort of a deal,” the judge said. “That’s how it appears. And we’re going to find out exactly what the deal is, because if there is a deal, I would consider it a fraud on the court.”

Adding to the chaos, the state attorney general’s office — the legal representative of the state — said it was unaware of the negotiations between the state and lawyers for the adult home industry “until it was well underway,” and asked last month to withdraw from the federal case, citing irreconcilable differences with its client, the state.

The highly unusual request was denied by Judge Garaufis, whose involvement in the case traces back to its beginnings.

The sprawling network of privately run and state-regulated adult homes in New York City — once considered a promising alternative to the bleak psychiatric wards that the state began closing in the 1960s — began to face increased scrutiny for a host of abuses. A 2002 investigation by The New York Times showed that many had “devolved into places of misery and neglect, just like the psychiatric institutions before them.”

Lawsuits were filed, and after years of court battles, the state reached a settlement that called for residents with mental illness to be moved out of the homes and into supportive housing and be given rental assistance and access to community-based services that promote their inclusion, independence and full participation in community life. The state was given five years to resettle 2,000 to 4,000 residents.

Diana Vila, one of the plaintiffs in the case, is one of the thousands of people who still have not been resettled to supportive housing.

She entered the system more than a decade ago, when a fire forced her from her apartment in Sunnyside, Queens.

She was already in a downward spiral, her depression worsening and her bipolar condition not properly medicated. Her mother, she said, was a victim of domestic abuse and had to escape to a shelter herself. Ms. Vila had recently lost her job and was growing distant from the rest of her family and friends.

With her apartment destroyed, she found herself in the hospital with no place to go.

So, as with thousands of other New Yorkers in desperate straits, she entered an adult home.

Ms. Vila, 54, was first sent to a home in Queens called Milestone. She described the conditions there as being “like a nightmare.”

There were frequent fights, a staff ill equipped to deal with people with mental illness, and general disarray.

To escape the home, Ms. Vila would get herself hospitalized as often as she could. After a year, she was transferred to Belle Harbor Manor in the Rockaways.

A couple of blocks from the beach, the facility was much cleaner and safer than Milestone, but it was still not home.

She misses her recliner chair, where she would sit with her cats and watch her favorite television programs. She misses cooking skirt steak and ordering takeout Chinese food. She misses hot chocolate heated up in her microwave and an occasional spoonful of ice cream at night. She misses buying cut flowers.

Like many others in the homes, Ms. Vila survives on disability benefits — $1,700 a month, in her case. She pays $1,500 to the adult home, which serves three meals a day. Breakfast is at 8 a.m., lunch is at noon and dinner is at 4:30 p.m.

She is left with $200 a month for everything else. After paying for her phone and cable, she has about $45 a month, which she uses to buy extra food.

Gaining control over her money — and by extension her life — was a big part of the reason she joined the lawsuit against the state.

“There’s so many things that I miss,” she said. “And it’s something that I want again.”

Last month, with the July deadline approaching, Judge Garaufis called all the parties into court for a hearing where, in blunt and caustic language, he warned that the state was “far from hitting its numbers.”

The state rejected the suggestion that it had done anything wrong.

“New York remains unequivocally committed to supporting adult home residents, which is why we are working tirelessly to meet the requirements of the settlement agreement,” the Department of Health wrote in a statement in response to a question.

Even before the hearing, however, advocates for the mentally ill said that the process for resettling residents was deeply flawed.

“The state’s system to help people move out of adult homes is not working,” said Cliff Zucker, the general counsel for Disability Rights New York. “Transition to community living has moved at a snail’s pace, leaving residents confused and frustrated. This is largely because the state has insisted on an inordinately complex process.”

The state officials, however, said that the complex process was necessary in part to ensure that people who moved out of the homes were ready to live more independent lives without endangering themselves or others.

Ms. Vila says she feels safe in her home, but safe is not a life.

“I am not growing,” she said. “I feel like I am standing still.”

Susan Beachy contributed reporting.

https://www.nytimes.com/2017/04/14/nyregion/adult-homes-mentally-ill-new-york.html?_r=0