Case: DOJ Investigation of South Carolina’s Use of Adult Care Homes to Serve Adults with Serious Mental Illness

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Case Summary

This investigation concerned South Carolina's treatment of adults with serious mental illness (SMI), particularly its reliance on segregated Community Residential Care Facilities (CRCFs). 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…

This investigation concerned South Carolina's treatment of adults with serious mental illness (SMI), particularly its reliance on segregated Community Residential Care Facilities (CRCFs). 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.

The investigation called for collaboration with the state; however, the DOJ retained the right to initiate a lawsuit to ensure compliance with the ADA if the state could not reach a resolution.

Summary Authors

(3/31/2024)

Documents in the Clearinghouse

Document

Investigation of South Carolina's Use of Adult Care Homes to Serve Adults with Serious Mental Illness

July 6, 2023

July 6, 2023

Findings Letter/Report

Findings Letter

July 6, 2023

July 6, 2023

Findings Letter/Report

Docket

Last updated Aug. 30, 2023, 1:44 p.m.

Docket sheet not available via the Clearinghouse.

Case Details

State / Territory: South Carolina

Case Type(s):

Mental Health (Facility)

Disability Rights

Public Benefits/Government Services

Key Dates

Case Ongoing: Yes

Plaintiffs

Plaintiff Description:

The Department of Justice, investigating and concluding that South Carolina violated the ADA by overly relying on segregated facilities for adults with SMI.

Plaintiff Type(s):

U.S. Dept of Justice plaintiff

Attorney Organizations:

U.S. Dept. of Justice Civil Rights Division

Public Interest Lawyer: Yes

Filed Pro Se: No

Class Action Sought: No

Class Action Outcome: Not sought

Defendants

The State of South Carolina, State

Defendant Type(s):

Jurisdiction-wide

Facility Type(s):

Government-run

Case Details

Causes of Action:

Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.

Special Case Type(s):

Out-of-court

Available Documents:

Non-settlement Outcome

Findings Letter/Report

Outcome

Prevailing Party: None Yet / None

Nature of Relief:

None yet

Source of Relief:

None yet

Issues

General/Misc.:

Deinstitutionalization/decarceration

Government services

Housing

Disability and Disability Rights:

Integrated setting

Least restrictive environment

Mental Illness, Unspecified

Reasonable Modifications

Discrimination Area:

Accommodation / Leave

Discrimination Basis:

Disability (inc. reasonable accommodations)

Medical/Mental Health Care:

Mental health care, general

Mental health care, unspecified