Case: United States v. South Carolina

This federal law suit arose from a Department of Justice (DOJ) investigation into South Carolina's treatment of adults with serious mental illness (SMI). The investigation found that there was reasonable cause to believe that South Carolina violated Title II of the Americans with Disabilities Act (ADA) by failing to provide services to individuals with SMI in the most integrated setting appropriate to their needs. The investigation called for collaboration with the state; however, the DOJ retained the right to initiate a lawsuit to ensure compliance with the ADA (for more details on the DOJ investigation, see “Detailed Summary of DOJ Investigation” below). 

On December 4, 2024, the DOJ filed suit against South Carolina in the United States District Court for the District of South Carolina in front of District Judge Cameron McGowan Currie. The DOJ alleged that South Carolina's programs violated Title II of the ADA (42 U.S.C. §§ 12132–34), by administering its service system for individuals with SMI in a manner that failed to ensure that they receive services in the most integrated setting appropriate to their needs. Specifically, the complaint alleged that South Carolina’s program unnecessarily institutionalized adults with SMI in Community Residential Care Facilities (“CRCFs”) when more integrated and appropriate settings were available.

The DOJ sought a declaration that South Carolina violated Title II of the ADA, an affirmative injunction that South Carolina cease discriminating against adults with SMI, and an order for other appropriate relief as the interests of justice may require. 

On January 3, 2025, South Carolina filed a motion to stay until March 21, 2025, to give the incoming Trump administration time to review this case and determine how to proceed. On January 15, 2025, the Judge denied the defendant's motion to stay, stating that South Carolina failed to show hardship if the action was not stayed.

On January 27, 2025, South Carolina filed a motion to dismiss the case claiming that the United States lacks standing to sue as a Plaintiff under the Americans with Disabilities Act (ADA) Title II. 

As of January 31, 2025, the motion to dismiss is pending and the case is ongoing. 

Detailed Summary of DOJ Investigation:

On July 6, 2023, the U.S. Department of Justice's Civil Rights Division (DOJ) announced the conclusion of an investigation into South Carolina's CRCFs, a.k.a. "adult care homes." The DOJ concluded there was reasonable cause to believe that South Carolina violated Title II of the Americans with Disabilities Act (ADA) by failing to provide services to individuals with SMI in the most integrated setting appropriate to their needs, emphasizing the importance of living and receiving services within their communities, in line with the ADA's integration mandate.

After opening the investigation on January 12, 2022, the DOJ's review included document analysis, interviews with state officials and facility staff, and site visits to CRCFs. This process also involved discussions with individuals with SMI, shedding light on their desire for integration into the community and the barriers they faced in achieving this goal.

The DOJ's findings revealed that South Carolina heavily depended on CRCFs to house individuals with SMI, a practice leading to unnecessary institutionalization. These facilities, housing approximately 2000 people, limited residents' independence and integration into the community. The investigation uncovered that residents, some of whom had lived in such settings for up to 35 years, were deprived of choice and autonomy. Meals, activities, and interactions were strictly regimented, with minimal opportunities for engaging with the broader community. Despite the state's acknowledgment that people with SMI could thrive in more integrated settings with appropriate support, critical community-based services like Assertive Community Treatment (ACT) and permanent supportive housing were either insufficiently available or entirely inaccessible to many in need.

The state's mental health system, designed to provide community-based services, fell short in practice. The mental health system, shared between the Department of Mental Health and the Department of Health and Human Services, showed significant gaps in providing for the needs of adults with SMI. While the state had established many necessary community-based services, the actual implementation and accessibility of these services did not meet the individuals' needs, contributing to the continued reliance on CRCFs for care. Critical services were unevenly distributed across the state, and efforts to connect individuals with necessary services to avoid CRCF placement or facilitate return to the community were lacking. 

Detailed accounts within the investigation underscore the lived experiences of residents, the systemic challenges they faced, and the potential for state reforms to foster greater independence and community integration for individuals with SMI. The investigation emphasized that South Carolina could feasibly adjust its existing programs to avoid the unnecessary segregation of adults with SMI in CRCFs, promoting living and thriving in community settings instead. In response to these findings, the DOJ outlined a series of remedial measures aimed at fostering greater community integration and independence for this population. The cornerstone of these recommendations was the expansion and accessibility of community-based services, including a statewide provision of ACT, peer support, supported employment, and other essential services, tailored to prevent unnecessary institutionalization and support independent living.Additionally, the DOJ stressed the critical need for South Carolina to enhance its integrated housing options, such as permanent supportive housing, to ensure individuals with SMI could live in the most integrated settings appropriate to their needs. The proposal advocated for substantial improvements in transition services from CRCFs to community settings. To prevent unnecessary admissions to CRCFs, the DOJ suggested implementing effective diversion strategies that connect individuals experiencing a mental health crisis directly to community-based services and supports, thus bypassing institutionalization.