Ending Segregation: The Right to Integrated Care and Services

The Americans with Disabilities Act

More than a decade after the settlement in the Brewster case, in 1990, Congress passed and President George W. Bush signed the Americans with Disabilities Act (ADA). The ADA prohibits discrimination, promotes integration, and ensures equal opportunity for persons with disabilities in employment, State and local government services, public accommodations, commercial facilities, and transportation. 

Congress charged the Attorney General (AG) with the responsibility to promulgate regulations to enforce Title II of the ADA, the part that prohibits discrimination by State and local governments. One of the most important parts of the AG’s regulations requires governments to provide programs and services to people with disabilities in the most integrated setting possible. The Supreme Court interpreted this regulation – which has come to be known as “the integration mandate” -- in Olmstead v. LC in 1999.


The Olmstead opinion

The Supreme Court held that unjustified segregation of persons with disabilities constitutes discrimination in violation of the ADA. Therefore, State and local governments must provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community-based treatment; and (3) community-based services can be reasonably accommodated, taking into account the resources available to the public entity and the needs of others who are receiving disability services from the entity.

The Supreme Court explained that "institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable of or unworthy of participating in community life." Second, "confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment."  (Source)

Since 1999, courts and the Department of Justice have interpreted the integration mandate to apply in settings other than mental health institutions – for example, segregated sheltered workshops, nursing homes, segregated schools and the like.

Many states have also developed “Olmsted plans” to implement the integration mandate including closing unneeded institutions and replacing them with integrated community based services and programs. The Massachusetts plan was drafted in 2008. The Commonwealth began to consider updating the plan in 2017.

MAMH supports the right of all individuals with mental illness to receive all services and programs in the most integrated setting possible.


For information about the ADA and integrated services contact MAMH or:

Center for Public Representation

Bazelon Center for Mental Health Law.

Department of Justice