WASHINGTON–The Justice Department said Tuesday that the U.S. District Court for the District of Delaware terminated the remedial settlement agreement governing the state of Delaware’s service system for people with serious and persistent mental illness.
The court agreed with the joint motion of the state and the Justice Department that Delaware had fully complied with the terms of the agreement, based on the assessment of an independent court monitor.
The state significantly expanded and enhanced community-based mental health services for individuals with serious and persistent mental illness under the agreement, as required by the Americans with Disabilities Act (ADA) and the Supreme Court’s Olmstead v. L.C decision. The agreement emphasized the need to transition institutionalized people to the community and prevent people from unnecessarily entering institutions.
“Our agreement prompted Delaware to institute comprehensive reforms and provide services to people with serious and persistent mental illness in integrated community settings,” said Principal Deputy Assistant Attorney General Vanita Gupta, head of the Justice Department’s Civil Rights Division. “Throughout this process, we saw the impact of the state’s hard work, leadership and commitment to drive positive change. People with mental illness in Delaware can now live in their own communities, engage with their families and friends and lead meaningful, fulfilling lives.”
Since entry of the agreement, the state has significantly reduced its reliance on institutional care, particularly at the state-run Delaware Psychiatric Center (DPC). It has reduced the number of bed days used by the target population in DPC by 47.2 percent. The number of Medicaid-eligible Delawareans receiving community-based services has increased by 92 percent since the United States began its investigation.
Delaware has developed a strong peer and self-advocacy movement that is incorporated into the entire service system: peers orient individuals upon their admission to DPC, assist them during the course of their hospitalization and provide personal care items upon discharge to the community; operate drop-in centers; conduct quality reviews of mental health services; and are essential members of Assertive Community Treatment, intensive case management, crisis apartment and crisis walk-in center teams.
The state has also established a robust quality assurance and performance improvement system in order to continue the reforms and address issues that may arise for people with mental illness in Delaware. These efforts will be sustained by recently passed legislation that established an independent oversight commission to monitor Delaware’s public mental health system.
These reforms to the state’s mental health system have also helped reduce unnecessary arrests and incarceration of people with SPMI. For instance, Delaware created two statewide mobile crisis teams that typically divert 80 to 90 percent of people they encounter from hospitalization and criminal justice interaction. The state’s crisis walk-in center in Sussex County diverts about 70 percent of people from further hospitalization or criminal justice interaction. This walk-in center reports that it takes law enforcement officers less than 10 minutes on average to drop-off an individual in a mental health crisis, which spares police officers an unnecessary and lengthy emergency room admission or jail booking process. Delaware also operates a peer program in the state’s Mental Health Court that serves people with SPMI or co-occurring disorders. Mental Health Court Peers support individuals throughout the process and help defendants access community resources that are necessary to increased stability in the community, including housing and transportation.
The department initiated its investigation pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), putting a primary focus on obtaining reforms to address violations of the ADA, as interpreted in Olmstead., requiring that individuals with disabilities receive services and supports in the most integrated setting appropriate to their needs. On Nov. 9, 2010, the United States issued a findings letter to Delaware that detailed systemic conditions and practices that violated the constitutional and statutory rights of individuals with serious and persistent mental illness in the state’s system.
The department has additional Olmstead settlement agreements in Georgia, Virginia, New Hampshire, New York, North Carolina, Oregon, Rhode Island and the city of Providence.