Justice Department Reaches Agreement with South Carolina to Ensure Adults’ Access to Community-Based Mental Health Services

Title II of the Americans with Disabilities Act (ADA) requires state and local governments to operate programs and services for people with disabilities in the “most integrated setting appropriate” to their needs. In practice, this means:

• Public entities must avoid unnecessarily segregating people with disabilities in institutions when reasonable community-based options are available.
• They must make reasonable modifications to policies, practices, and funding structures to allow people with disabilities to receive services in community settings, unless doing so would fundamentally alter the program.
• People with disabilities should have equal opportunity to live, work, and receive services alongside people without disabilities, rather than being routed by default into institutional or congregate facilities. These principles are often called the ADA’s “integration mandate,” and are enforced in part through the Supreme Court’s decision in Olmstead v. L.C.

Olmstead v. L.C., 527 U.S. 581 (1999), is a Supreme Court case interpreting Title II of the ADA. Two women with mental disabilities were kept in a Georgia psychiatric hospital even after state professionals said they could live in the community with appropriate services. The Court held that:

• Unjustified institutionalization of people with disabilities is a form of discrimination under the ADA.
• States must provide community-based treatment for persons with mental disabilities when: (1) treatment professionals say it is appropriate; (2) the individuals do not oppose community placement; and (3) it can be reasonably accommodated, considering the state’s resources and the needs of others. Applied to mental health services, Olmstead requires states to shift from default reliance on psychiatric hospitals and adult care homes toward robust community-based mental health systems (e.g., supported housing, mobile crisis, intensive community treatment), so people with serious mental illness can live and receive services in integrated settings rather than being unnecessarily segregated. The Justice Department’s lawsuit and settlement with South Carolina invoke Olmstead to challenge the state’s practice of placing adults with serious mental illness in Community Residential Care Facilities instead of providing adequate community-based services.

In South Carolina, Community Residential Care Facilities (CRCFs) are state‑licensed group living settings (often called assisted living) that provide:

• Room and board,
• Supervision,
• A limited level of personal care and medication management for two or more adults who are not related to the owner. They are congregate facilities, not individualized mental health programs, and many residents have serious mental illnesses.

Community‑based mental health services, by contrast, are supports delivered in people’s own homes or ordinary housing in the community (not in an institution or facility). Examples include:

• Outpatient therapy and psychiatric care,
• Intensive community treatment teams (such as ACT or community support teams),
• Case management, supported employment, and peer support,
• Rental subsidies and supported housing scattered in regular neighborhoods.

The DOJ’s complaint argued that South Carolina was using CRCFs as institutional placements for adults with serious mental illness instead of giving them access to these less restrictive, individualized community services, leading to unnecessary segregation under the ADA and Olmstead.

In this context, these terms refer to specific types of community mental health supports:

• Intensive mental health services These are high‑intensity, community‑based services for people with serious mental illness who need more than standard outpatient care. In practice they often include:

• Assertive Community Treatment (ACT) or similar multidisciplinary teams that provide psychiatric care, medication support, skills training, and help with daily living in the person’s own home or community.
• Community support teams or intensive case management that meet frequently with clients, coordinate all services, and are available outside normal office hours. The South Carolina settlement requires building enough of this type of intensive community capacity so people in CRCFs can transition to integrated housing with appropriate supports.

• Peer support services Peer support uses trained staff who have lived experience of mental illness or recovery. Certified peer support specialists:

• Offer emotional support, mentoring, and practical guidance,
• Help people engage in treatment and community life,
• Model recovery and self‑advocacy. These services are typically offered one‑on‑one or in groups in community settings, not institutions.

• Mobile crisis response services Mobile crisis teams are mental‑health crisis responders who go to the person wherever the crisis is happening (home, street, shelter, etc.) instead of requiring them to go to an emergency room or jail. According to federal crisis‑care guidelines, mobile crisis teams:

• Are available 24/7 or close to it,
• Include clinicians and often peer specialists,
• De‑escalate the situation, assess risk, provide short‑term treatment, and connect people to ongoing community services,
• Aim to avoid unnecessary hospitalization, police involvement, or incarceration. The settlement requires that mobile crisis response be available statewide so people with serious mental illness can remain safely in the community during crises.

The settlement agreement sets out multi‑year obligations and formal monitoring by the Justice Department:

• Duration: The agreement lasts 9 years from the court’s approval, with the possibility of extension if South Carolina is not in substantial compliance toward the end of that period.
• DOJ monitoring: The U.S. will: • Review detailed implementation plans and annual or periodic data reports (e.g., numbers of people identified in CRCFs, those offered community services, housing units and intensive service slots created). • Conduct on‑site reviews, including visits to CRCFs and to community programs. • Interview state staff, providers, and class members, and review individual records.
• Court involvement: The parties jointly asked the federal district court to dismiss the DOJ lawsuit without prejudice while the agreement is implemented. The court retains jurisdiction to enforce the agreement during the term, meaning DOJ can go back to court if it believes South Carolina is not complying. Monitoring continues throughout the 9‑year term until the U.S. determines South Carolina has achieved sustained, substantial compliance with all material requirements.

If South Carolina fails to implement the settlement, it faces both legal and practical consequences:

Legal consequences

• Enforcement by DOJ: Because the settlement is filed with and overseen by the federal district court, the Justice Department can: • Formally notify the state of noncompliance and demand corrective action. • Seek judicial enforcement, including orders compelling specific performance (e.g., creation of services or housing) or other injunctive relief.
• Revival of the lawsuit: The DOJ lawsuit against South Carolina was dismissed without prejudice, meaning DOJ can move to reinstate or re‑file its ADA/Olmstead claims if the state materially breaches the agreement.
• Potential contempt sanctions: If the court finds willful noncompliance with its orders, it can impose sanctions such as monetary fines or other remedial measures to coerce compliance.

Practical consequences

• Continued violation of the ADA and Olmstead: Ongoing unnecessary segregation of adults with serious mental illness would expose the state to further federal enforcement, private litigation, and reputational damage.
• Loss of negotiated flexibility: If the agreement breaks down, remedies could be imposed through litigation that are less tailored and give the state less control over timelines and program design.

Individuals can report possible civil rights violations directly to the Justice Department’s Civil Rights Division using the online portal at civilrights.justice.gov.

How to report

• Go to https://civilrights.justice.gov/ and choose the option to “Submit a report.”
• Provide: • What happened (facts, dates, location), • Who was involved (agencies, facilities, or individuals), • The type of discrimination or rights violation (e.g., disability discrimination, police misconduct, housing, voting, etc.), • Contact information and whether you want DOJ to contact you. You can submit on your own behalf or on behalf of someone else. DOJ policy says recipients of Justice Department funds may not retaliate against you for filing a complaint.

What happens after submission

• Screening and routing: DOJ staff review the report, categorize the issue, and decide which section or agency (e.g., Disability Rights Section, Housing, Voting, or another federal partner) should get it.
• Initial review: The Civil Rights Division determines whether it has legal authority and sufficient information to open an investigation or case. They may contact the complainant for more details or documents.
• Possible actions: • Open a formal investigation, compliance review, or lawsuit, • Refer the matter to another federal or state agency better positioned to act, • Use the information for pattern‑or‑practice monitoring even if no individual case is opened.
• Notification: DOJ typically sends a letter or email explaining whether it will investigate, has referred the matter, or is closing the report, and provides general information about other resources when applicable.