1. Two Important Alabama Cases

2. R.C. v. Fuller

3. Bill Fuller, Commissioner of the Alabama Department of Human Resources (DHR) Bill Fuller, Commissioner of the Alabama Department of Human Resources (DHR) Case has changed names as new commissioners are appointed Case has changed names as new commissioners are appointed Originally filed in 1988 Originally filed in 1988

4. Who was R.C.? Emotionally disturbed child Emotionally disturbed child Removed from the family home due to allegations of abuse and neglect Removed from the family home due to allegations of abuse and neglect Though he had never been diagnosed as psychotic or seriously mentally ill, Though he had never been diagnosed as psychotic or seriously mentally ill, Given large doses of psychoactive medications while in the state's custody. Given large doses of psychoactive medications while in the state's custody.

5. What did DHR do? First, DHR placed R.C. in a psychiatric hospital for a few weeks. First, DHR placed R.C. in a psychiatric hospital for a few weeks. Next, they transferred him to the psychiatric unit of a second hospital for six months. Next, they transferred him to the psychiatric unit of a second hospital for six months. R.C. left the psychiatric unit for a few days then returned for another six-month stay. R.C. left the psychiatric unit for a few days then returned for another six-month stay. Next stop was a home for children who are psychotic or suffer serious behavioral disorders. Next stop was a home for children who are psychotic or suffer serious behavioral disorders. Medicated, restrained, and isolated Medicated, restrained, and isolated

6. What did DHR do? R.C.'s father tried to visit and was denied access to his son R.C.'s father tried to visit and was denied access to his son Institutional authorities labeled R.C.'s father a troublemaker due to his protests regarding R.C.'s treatment and lack of access of family visitation Institutional authorities labeled R.C.'s father a troublemaker due to his protests regarding R.C.'s treatment and lack of access of family visitation After the lawsuit was filed on R.C.'s behalf, DHR returned R.C. to his father but offered no assistance to the family After the lawsuit was filed on R.C.'s behalf, DHR returned R.C. to his father but offered no assistance to the family

7. Plaintiffs asserted that DHR violated their constitutional rights to: Family integrity Family integrity Proper care while in state custody Proper care while in state custody Adequate mental health care Adequate mental health care Reasonable efforts toward reunification Reasonable efforts toward reunification Freedom from discrimination on the basis of their disabilities Freedom from discrimination on the basis of their disabilities

8. Results Solve problems instead of simply removing children from the home; Solve problems instead of simply removing children from the home; Investigating allegations of abuse and neglect faster; Investigating allegations of abuse and neglect faster; Providing appropriate and stable placements for children removed as a last resort; Providing appropriate and stable placements for children removed as a last resort; Reducing caseloads for social workers and investigators; Reducing caseloads for social workers and investigators; Devoting more resources to the DHR county agencies; and Devoting more resources to the DHR county agencies; and Providing appropriate mental health services for children with special needs. Providing appropriate mental health services for children with special needs.

9. Consent Decree Required the creation of a "system of care" Required the creation of a "system of care" Principles emphasizing placement prevention, family reunification, permanency, and home- based and community-based services. Principles emphasizing placement prevention, family reunification, permanency, and home- based and community-based services. Designed to assist children (1) with emotional or behavioral disorders who are in foster care; (2) with emotional or behavioral disorders who are at imminent risk of foster care placement; and/or (3) at imminent risk of foster care placement who are at high risk of developing emotional or behavioral disorders. Designed to assist children (1) with emotional or behavioral disorders who are in foster care; (2) with emotional or behavioral disorders who are at imminent risk of foster care placement; and/or (3) at imminent risk of foster care placement who are at high risk of developing emotional or behavioral disorders.

10. Consent Decree Protect children from abuse and neglect Protect children from abuse and neglect Enable the children to live with their families Enable the children to live with their families Achieve permanency and stability Achieve permanency and stability Become stable, gainfully employed adults pursuant to an individualized service plan. Become stable, gainfully employed adults pursuant to an individualized service plan. Structured to ensure that family preservation services are provided to most children at imminent risk of foster placement. Structured to ensure that family preservation services are provided to most children at imminent risk of foster placement.

11. Wyatt v. Stickney

12. Ended December 5, 2003 after 33 years Ended December 5, 2003 after 33 years Longest running mental health lawsuit in U.S. history Longest running mental health lawsuit in U.S. history The ruling decreed that people with mental disabilities had a constitutional right to personal treatment with minimum standards of care. The ruling decreed that people with mental disabilities had a constitutional right to personal treatment with minimum standards of care. Included staffing, diet and nutrition, safety, physical plant adequacy, etc. Included staffing, diet and nutrition, safety, physical plant adequacy, etc.

13. Wyatt v. Stickney 9 Alabama governors 9 Alabama governors 14 state mental health commissioners 14 state mental health commissioners Litigation expenses at over $15 million Litigation expenses at over $15 million

14. Lessard v. Schmidt Changed involuntary commitment policy. Changed involuntary commitment policy. 1971 Federal Court in Milwaukee struck down Wisconsin's commitment law as unconstitutional. 1971 Federal Court in Milwaukee struck down Wisconsin's commitment law as unconstitutional. Traditional parens patriae grounds for commitment abolished. Traditional parens patriae grounds for commitment abolished. Commitment statutes in most states were too broad and vague and procedural protections absent. Commitment statutes in most states were too broad and vague and procedural protections absent. Could be committed if considered "a proper subject for custody and treatment." Could be committed if considered "a proper subject for custody and treatment."

15. Lessard v. Schmidt Established dangerousness standard for involuntary commitment. Established dangerousness standard for involuntary commitment. “Extreme likelihood that if the person is not confined he will do immediate harm to himself or others.” “Extreme likelihood that if the person is not confined he will do immediate harm to himself or others.” Individual to be accorded all the procedural protections of the criminal law. Individual to be accorded all the procedural protections of the criminal law.

16. “The enormity of what this case has accomplished cannot be overstated. The principles of humane treatment of people with mental illness and mental retardation embodied in this litigation have become part of the fabric of law in this country and, indeed, international law.” - Judge Myron Thompson

17. So what started all of this?

18. A cut in Alabama's cigarette tax.

19. The Beginnings Filed in October of 1970 on behalf of Ricky Wyatt Filed in October of 1970 on behalf of Ricky Wyatt Patient at Bryce Hospital Patient at Bryce Hospital a fifteen-year-old who had always been labeled a "juvenile delinquent“ a fifteen-year-old who had always been labeled a "juvenile delinquent“ Was not diagnosed with a mental illness Was not diagnosed with a mental illness Aunt was a Bryce employee Aunt was a Bryce employee

20. The Beginnings Initial suit response to layoffs of employees due to budget constraints Initial suit response to layoffs of employees due to budget constraints Over 100 employees including over 20 professional staff Over 100 employees including over 20 professional staff Mental health employees filed suit, including the superintendent, Dr. Stonewall Stickney Mental health employees filed suit, including the superintendent, Dr. Stonewall Stickney

21. The Beginnings Argued that lay-offs of professional staff would preclude even minimal treatment of patients at Bryce Argued that lay-offs of professional staff would preclude even minimal treatment of patients at Bryce Adding the patient enabled the suit to allege that patients' treatment suffered as a result of the layoffs. Adding the patient enabled the suit to allege that patients' treatment suffered as a result of the layoffs. Federal District Judge Frank M. Johnson dismissed the part of the suit brought by the professionals. Federal District Judge Frank M. Johnson dismissed the part of the suit brought by the professionals. Consented to hear the part of the suit dealing with the patients' grievances. Consented to hear the part of the suit dealing with the patients' grievances.

22. Conditions in 1970 Three psychiatrists to serve over 5,000 patients Three psychiatrists to serve over 5,000 patients Other professional staffing deplorably low Other professional staffing deplorably low Discharge was virtually impossible Discharge was virtually impossible Intolerable conditions and improper treatments designed only to make the patients more manageable Intolerable conditions and improper treatments designed only to make the patients more manageable Food budget at 50 cents a day Food budget at 50 cents a day

23. “Human feces were caked on the toilets and walls; urine saturated the aging oak floors; many beds lacked linen; some patients slept on floors. Archaic shower stalls had cracked and spewing shower heads. One tiny shower closet served 131 male patients; the 75 women patients also had but one shower. Most of the patients at Jemison were highly tranquilized and had not been bathed in days. All appeared to lack any semblance of treatment. The stench was almost unbearable."

24. Photographs by Chip Cooper

29. By Chip Cooper

34. The Case Judge Johnson gave the state six months to implement fully the "right to treatment" at Bryce Hospital. Judge Johnson gave the state six months to implement fully the "right to treatment" at Bryce Hospital. When state failed, he laid out specific requirements the hospital would have to meet. When state failed, he laid out specific requirements the hospital would have to meet. Assumption was that if these objectively measurable conditions were met, treatment would necessarily follow. Assumption was that if these objectively measurable conditions were met, treatment would necessarily follow. Included such things as how often linen had to be changed, how many showers a patient should receive, and what furniture should be in the dayroom. Included such things as how often linen had to be changed, how many showers a patient should receive, and what furniture should be in the dayroom.

35. The Case State appealed but circuit court held up decision State appealed but circuit court held up decision In June 1977, complaining that the state was still not living up to the mandated standards, the plaintiffs succeeded in obtaining a federal court office to monitor state compliance with Wyatt standards. In June 1977, complaining that the state was still not living up to the mandated standards, the plaintiffs succeeded in obtaining a federal court office to monitor state compliance with Wyatt standards. Office abolished in 1986 Office abolished in 1986 Case ended December 5, 2003 Case ended December 5, 2003

36. Results Court-ordered agreements formed the basis for federal minimum standards for the care of people with mental illness or mental retardation who reside in institutional settings. Court-ordered agreements formed the basis for federal minimum standards for the care of people with mental illness or mental retardation who reside in institutional settings. Seminal case in achieving drastic deinstitutionalization of previously committed patients. Seminal case in achieving drastic deinstitutionalization of previously committed patients. Population at state psychiatric hospitals reduced by almost two-thirds between 1970 and 1975 (even while expenditures were increased by 327%) Population at state psychiatric hospitals reduced by almost two-thirds between 1970 and 1975 (even while expenditures were increased by 327%)

37. Results Set minimum standards of care Set minimum standards of care Established patient rights Established patient rights Fostered the downsizing of state institutions Fostered the downsizing of state institutions Proliferation of community services Proliferation of community services Consumers now sit on boards Consumers now sit on boards Led to Olmstead v. L.C. decision Led to Olmstead v. L.C. decision ADA may require states to provide community- based services rather than institutional placements for individuals with disabilities ADA may require states to provide community- based services rather than institutional placements for individuals with disabilities Least restrictive environment Least restrictive environment

38. Unfortunate Results State invested an enormous sum of money on improvements to outmoded buildings which were promptly abandoned as large numbers of patients were released State invested an enormous sum of money on improvements to outmoded buildings which were promptly abandoned as large numbers of patients were released Throughout the country, patients were dumped from hospitals, supposedly to be cared for in the community without alternative facilities in place to care for them. Throughout the country, patients were dumped from hospitals, supposedly to be cared for in the community without alternative facilities in place to care for them. Community mental health not properly funded Community mental health not properly funded Many who would have gotten care in mental institution now “warehoused” in prisons and jails Many who would have gotten care in mental institution now “warehoused” in prisons and jails

39. "Wyatt Standards" Humane psychological and physical environment Humane psychological and physical environment Qualified and sufficient staff for administration of treatment Qualified and sufficient staff for administration of treatment Individualized treatment plans Individualized treatment plans Minimum restriction of patient freedom. Minimum restriction of patient freedom.

40. “There can be no legal or moral justification for the State of Alabama's failing to afford adequate treatment for persons committed to its care from a medical standpoint. Furthermore, to deprive any citizen of his or her liberty upon the altruistic theory that the confinement is for humane therapeutic reasons and then fail to provide adequate treatment violates the very fundamentals of due process.” —Federal Judge Frank M. Johnson, Jr.