1. Addictions and Mental Health The Olmstead Decision and Oregon’s Olmstead Plan Implications for Coordinated Care Organizations Residential Transition to CCOs Learning Session Four Webcast: February 28, 2014

2. Addictions and Mental Health 2 Presenters Micky Logan, JD Legal Affairs Director Oregon State Hospital Nicole Currier Project Coordinator Mental Health America – Oregon Rick Wilcox Community Transition/Olmstead Coordinator Addictions and Mental Health Oregon Health Authority

3. Addictions and Mental Health 3 Introduction The 1990 Americans with Disabilities Act (ADA) established the rights of persons with disabilities to live productive, meaningful lives and to be fully integrated into the communities in which they live. –The Olmstead vs. L.C. United States Supreme Court decision of 1999 further clarified these rights extend to persons experiencing mental illness and intellectual disabilities. –The court further directed that states make reasonable efforts to ensure their mental health service delivery systems complied with the Olmstead decision.

4. Addictions and Mental Health 4 Introduction CCOs should collaborate with stakeholders to promote this philosophy because: –Right thing to do –Improve treatment outcomes –Lower overall costs CCOs can assist stakeholders in accomplishing a needed paradigm shift –Planful use of high intensity treatment resources –Increased emphasis on recovery vs. symptom management –Increased opportunities to promote independence and community integration for plan members

5. Addictions and Mental Health 5 Table of Contents A Brief History of the Americans With Disabilities Act and the Olmstead Decision Explanation of Concepts Challenges to Integration A Brief History of Implementation Efforts Summary of Oregon’s Olmstead Plan Implications for CCOs

6. Addictions and Mental Health 6 Americans with Disabilities Act The 1990 Americans with Disabilities Act (ADA) confirmed that persons with disabilities have the right to equality in: »Employment; »Housing; »Education; and »Community Access And are entitled to reasonable accommodation to ensure this equality

7. Addictions and Mental Health 7 Olmstead vs. L.C. - 1999 Lawsuit against the State of Georgia Determined that it is a violation of the ADA to treat persons with intellectual disabilities/mental illness in a segregated setting when they could be effectively served in a less restrictive more integrated setting. Segregation reinforces: –The myth that persons with disabilities are incapable of participating in society –Isolation and exclusion from everyday life

8. Addictions and Mental Health 8 Olmstead principles ADA Integration Mandate- requires that state and local governments : “administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities” Consumer Choice- The ADA and the subsequent “Olmstead” Supreme Court decision address civil rights. The most basic of human rights is the freedom to make life choices; consumers should have the freedom to decide what type of living arrangement they want and what services they choose to use.

9. Addictions and Mental Health 9 What is Reasonable Accommodation? Decided on a case-by-case basis Title II of the ADA requires –Public entities make “reasonable accommodation” unless to do so entails a “fundamental alteration” of the entity’s services, programs, or activity Fundamental Alteration –Decided on a case-by-case basis

10. Addictions and Mental Health 10 What is an integrated setting? State hospital? Own apartment/home? Locked program in the community? Adult foster home? Homeless shelter? In my own apartment in a complex exclusively for individuals with mental illness? Tent in the park? A group home where I can come and go as I please, and be as involved as I want in the activities of my community?

11. Addictions and Mental Health 11 Institutions according to Olmstead State and acute care hospitals Residential treatment facilities Group homes Adult foster homes Prisons/jails Any congregate setting with more than 20% of units reserved for persons with disabilities

12. Addictions and Mental Health 12 Characteristics of institutions Congregate/group living not of the resident’s choosing Restricted egress-locked doors, staff escort Externally imposed schedule Curfews House rules No choice of roommates Mandatory participation in services to retain housing

13. Addictions and Mental Health 13 Challenges to integration Previous Paradigms Inflexible funding streams Fear Residential or “group home” models NIMBY (Not in My Back Yard)

14. Addictions and Mental Health 14 Back to the Olmstead decision 1999-2009 –June 19, 2001, executive order authorizes the United States Attorney General, and the Secretaries of Health and Human Services, Education, Labor, and Housing and Urban Development to work together to ensure “swift implementation” –Numerous lawsuits and briefs filed nationwide, eventually resulting in several settlements, most notably in Georgia, where Olmstead vs. L.C. was filed

15. Addictions and Mental Health 15 Back to the Olmstead decision 2009-Present –Obama Administration makes Olmstead enforcement a priority –More lawsuits and settlements –More investigations by the US Department of Justice –Growing consumer/survivor voice –Building momentum

16. Addictions and Mental Health 16 Oregon’s Olmstead plan Olmstead Plan Five principle areas of focus: 1.Preventing State Hospitalization 2.Reducing State Hospital Length of Stay 3.Ensuring Individuals Get The Services They Need 4.Housing and Supported Housing 5.Expanding the Quality and Availability of Community Supports

17. Addictions and Mental Health 17 Oregon’s Olmstead Plan Provide sufficient community resources to avoid hospitalization and reduce utilization of costly resources Increase consumer voice in state and local mental health agencies Empower consumers with increased choice of options Enhance strategies to promote local decision making regarding resources, as well as promoting accountability for outcomes Encourage community integration Promote “unbundling” housing from services Encourage “outside the box” thinking to meet individual consumer need

18. Addictions and Mental Health 18 What does this mean for CCOs? Increased ability to avoid crisis (and high cost interventions) through utilization of community based strategies Increased utilization of Peer Support and Traditional Health Workers focusing on wellness and recovery Close collaboration with Community Mental Health Programs to wrap services in the community

19. Addictions and Mental Health 19 Further information Bazelon Center for Mental Health Law www.bazelon.org Center for Personal Assistance Services www.pascenter.org Disability Right Oregon www.disabilityrightsoregon.org Substance Abuse and Mental Health Services Administration www.samhsa.gov www.samhsa.gov

20. Addictions and Mental Health 20 Contacts Micky Logan 503-947-2937 micky.f.logan@state.or.us Nicole Currier 503-922-2377 nicolemhao@gmail.com Rick Wilcox 503-945-5955 richard.a.wilcox@state.or.us

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