#institutionalization

Cory Turner at NPR:

The Justice Department released a memo this week that quietly calls into question decades of civil rights protections for Americans with disabilities and stirred fear and anger among advocates and families. The memo, an opinion from the Office of Legal Counsel, argues that states do not have to provide in-home or community-based care to people with disabilities who need support. These services allow many disabled Americans to continue to live, learn and work at home or in their own communities, among family and friends. "It is now the position of the United States government that people with disabilities don't have a right to be part of their communities," says Alison Barkoff, a health law and policy professor at George Washington University who led disability law and policy efforts during both the Obama and Biden administrations. "I can't overstate how significant this change in position is." Without the federal government requiring that states provide these services – to help disabled people integrate into their communities – advocates and legal experts warn that cash-strapped states could cut them and return to what was once common practice: de facto segregation of Americans with disabilities in nursing homes and large institutions.

Pushback from the disability community was swift. "As America prepares to celebrate 250 years of independence, [this memo] threatens to drag our nation back to a dark and shameful era of ignorance and cruelty," said the American Association of People with Disabilities. "This interpretation will open the doors for states to revert to warehousing people with disabilities out of sight and out of mind in institutions." "This opinion is a direct threat to decades of progress toward community living for people with disabilities," said Shira Wakschlag of The Arc of the United States, a nonprofit disability advocacy group. "People with disabilities shouldn't be forced into institutions because a state refuses to provide services in the community." The Justice Department did not respond to an NPR request that it explain its position as well as why it is changing course after decades of legal and bipartisan support for community services.

What the law says

This new memo calls into question what legal experts say has been settled law for decades. Both Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act have long been interpreted to require that states provide services to Americans with disabilities in the most integrated setting appropriate. In short: Institutionalization should be a last resort. In 1999, a case testing these protections made it to the U.S. Supreme Court. In Olmstead v. L.C., two women with mental disabilities sued Georgia, arguing that the state had failed its obligation to provide services that would allow them to return to their communities and that it had continued to institutionalize the women instead, thus violating their civil rights. The court agreed that states have a legal responsibility to provide support that integrates disabled Americans into their communities, and for nearly three decades, courts across the country have embraced that interpretation. By 2023, 8.4 million Americans were receiving home- and community-based services through Medicaid.

[...]

Why it matters

"The United States government since 1977 has taken the position that [federal law] includes an integration mandate that requires services to be provided in the most integrated setting appropriate," says professor Barkoff, who worked in the Obama Justice Department leading its Olmstead enforcement efforts. For decades, Barkoff adds, both Republican and Democratic administrations, including the first Trump administration, proactively enforced federal disability law and repeatedly brought actions against states that relied too heavily on care in large, segregated settings that the law says should be a last resort.

The courts and Congress decided institutionalization should be a last resort because people's personal liberty is at stake, says Jennifer Mathis of the Bazelon Center for Mental Health Law: "Who you can see, when you can go out, when you eat, what you eat. Who your roommate is, who you talk to, what your environment is. And for so many people who are institutionalized, their life is literally a hallway. I have been on those hallways with people. It is deadening." This memo signifies a dramatic change in the U.S. government's official position. "We are incredibly concerned that the message coming from the federal government in this memo is, 'It's fine to go back to the days that people were placed in institutions,' even though they can be served in the community, even though they want to be and even though it's more cost-effective," Barkoff says.  The timing matters too. The memo arrives as a new case, Texas v. Kennedy, is making its way through the courts. The case, brought by Texas and several other states, is essentially a fresh challenge to the integration mandate on states.

[...]

Why now?

The Justice Department memo appears to be the latest salvo in a broader effort that began on July 24, 2025, when President Trump issued an executive order intended to make it easier for state and local governments to police homelessness. "Endemic vagrancy, disorderly behavior, sudden confrontations, and violent attacks have made our cities unsafe," the order argues, going on to claim that "the overwhelming majority of these individuals are addicted to drugs, have a mental health condition, or both." The administration's solution: Involuntary institutionalization. "Shifting homeless individuals into long-term institutional settings for humane treatment through the appropriate use of civil commitment will restore public order," the order reads.

[...] One serious obstacle to large-scale institutionalization of the unhoused is federal disability law that has long required home- or community-based services instead, when appropriate. A footnote in the Justice Department's new memo appears to suggest these laws have contributed to the rise in chronic homelessness. To the contrary, Barkoff says, the Olmstead decision "has been one of the most effective tools in providing services and stable housing to people who are homeless." NPR has previously reported that the Trump administration's push for institutionalization faces another big obstacle: An acute shortage of beds at these specialized facilities. The memo arrives as Republicans have also passed deep cuts to Medicaid, which is the primary source of funding for community-based services many disabled Americans rely on.

The Trump Regime’s US Department of Injustice released a memo attacking the dignity of people with disabilities by arguing that states should not have to provide in-home or community-based care to people with disabilities who need support.

See Also:

Disability Scoop: Trump Administration Claims People With Disabilities Don’t Have Right To Community-Based Services

Have had two deeply awful nightmares about psych ward and being denied aac and other communication and stuff

And like I get them from time to time but two days in a row is unusual without triggers happening during the day

And it finally dawned on me that this week is indeed that 4 year anniversary to the last psych hold that was so fucking awful and had no means of communication besides crayons

So uh. Makes sense.

Also I hate it and can it please stop

How many years am I going to be tormented by this

Still tormented by my first one which was 15 years ago. So. Okay.