Since its first major system reform case on behalf of residents of the Northampton State Hospital, the Center has had a unique interest and expertise in phasing down public psychiatric hospitals and promoting the community integration of their residents. Its efforts have resulted in the successful closure of several facilities in Massachusetts, Florida, and other States.
Documents and pleadings which may be helpful to attorneys litigating or considering the litigation of disability law related cases are available by following the links below.
The jointly-appointed Expert Reviewer, Stephen Day, filed his first report with the Court describing the status of implementation of the Community Mental Health Settlement Agreement in Amanda D. v. Hassan. The report describes the Reviewer’s activities over the past six months, his observations of New Hampshire’s community mental health system, initial developmental efforts to expand mobile crisis, ACT, supported housing, and supported employment programs, and his concerns about the lack of data to assess compliance. Because most of his activities during this first reporting period involved orientation to the existing service system, this report does not contain any compliance assessments.
February 27, 2014: Landmark Settlement Agreement Approved in Longstanding Class Action Case, Arnold v. Sarn
After a fairness hearing on February 27, 2014, Judge Edward Bassett approved a landmark settlement agreement in Arnold v. Sarn, a longstanding class action on behalf of more than 23,000 persons with serious mental illness in Maricopa County, Arizona. The settlement requires the State to create up to 1500 additional supported housing units, 1250 supported employment placements, 13 ACT teams, and 1500 peer support services.
Agencies providing these services must comply with SAMSHA fidelity standards for each program model. Using trained and qualified reviewers, the State must conduct annual evaluations of all agencies providing these services, and take corrective actions to ensure compliance with these standards. In addition, the State must conduct annual independent reviews of a sample of class members to determine if their support needs are being met, as well as separate independent reviews of the capacity of the service system to meet the overall needs of persons with serious mental illness in the County.
If the State complies with its initial obligations, the case will be dismissed in September 2014, pursuant to an order which allows the Court to continue its jurisdiction and enforcement authority over the settlement on an indefinite basis.
The Governor of Arizona, as well as many senior state officials, attended the entire fairness hearing. In addition to presentations by attorneys for all parties, Governor Brewer addressed the Court, urging it to approve the settlement agreement. She said the settlement was one of the most significant achievements of her administration, and "would bind future governors and executive officials, requiring all of them to continue to ensure that the needs of persons with serious mental illness are fully met."
Read the final settlement agreement and the notice to class. The case is litigated by the Center for Public Representation, the Arizona Center for Law in the Public Interest, and the Arizona Disability Law Center.
February 12, 2014: Comprehensive Settlement Agreement Approved in New Hampshire Olmstead Case
Following several months of intensive negotiations, the parties in Amanda D. v. Hassan submitted a Joint Motion for Final Approval of their proposed Comprehensive Settlement Agreement. On February 12, 2014, that Agreement was approved as fair and reasonable and entered as an order of the District Court, ushering in a period of significant investment in, and expansion of, the community mental health system in New Hampshire.
As described in the plaintiffs’ Memorandum in Support of Final Approval, the Agreement has received wide-spread support from class members, family and public guardian organizations, and clinical and policy experts familiar with the New Hampshire system.
Under the terms of the Agreement, the State will expand its community service capacity over the next five years, providing four evidence-based, community mental health services – mobile crisis teams and crisis apartments, Assertive Community Treatment, Supported Housing and Supported Employment. These services are designed to promote community integration and to help class members avoid unnecessary hospitalization and institutionalization. The Agreement also ensures New Hampshire will maintain and increase its funding for peer and family supports.
A new person-centered transition planning process will facilitate class members’ access to these services, offering in-reach to those currently institutionalized in New Hampshire Hospital and the Glencliff Home, identifying individuals’ needs and preferences, developing discharge plans, and coordinating the provision of care and treatment in the community. Annual community service reviews will be used to measure the quality of service delivery and to ensure class members have opportunities for increased independence and community integration. An Expert Reviewer, jointly selected by the parties, will monitor these implementation efforts, and assess the State’s compliance with the terms of the Agreement.
Finally, the Agreement enables the District Court to maintain jurisdiction over the underlying litigation and to use its equitable authority to enforce the terms of the Agreement in the event of any future noncompliance.
January 8, 2014: Landmark Settlement Agreement to Expand Community Mental Health Services and Resolve the Historic Arnold v. Sarn Litigation
The Arizona Center for Law in the Public Interest, the Center for Public Representation, and the Arizona Center for Disability Law filed a landmark settlement agreement that will dramatically expand mental health services to allow individuals with serious mental illness to live independent and productive lives in the community. The settlement resolves the long-standing case of Arnold v. Sarn, which was the first class action suit to enforce a state statute requiring the State to provide community mental health services to all persons with serious mental illness.
The settlement will expand ACT, supported housing, supported employment, and peer and family services for up to 20,000 persons with serious mental illness in Maricopa County, Arizona. The Governor of Arizona, a signatory to the agreement, called it “a landmark day for our state, particularly for the thousands of Arizonians living with Serious Mental Illness who finally have better access to the quality community-based resources and the care and services they deserve.”
December 20, 2013: Proposed Settlement Reached in New Hampshire Olmstead Case
Following several months of negotiations between the plaintiffs, the Department of Justice and State defendants, the parties in Amanda D. v. Hassan executed a comprehensive Settlement Agreement on December 19, 2014. This Agreement will significantly expand community-based services for a class of adults with serious mental illness institutionalized at New HampshireHospital or Glencliff nursing home, or at serious risk of institutionalization at these facilities.
A Joint Motion for Preliminary Approval , filed with the Court on December 19, 2013, describes the substance of the Agreement, as well as provisions for its enforcement and monitoring. A hearing to determine if the proposed Agreement is fair and reasonable is requested for mid-March, 2014.
The proposed Agreement enhances and expands community-based services for individuals with serious mental illness by increasing the availability of Assertive Community Treatment, supported housing and supported employment. The Agreement also calls for the development of mobile crisis services and crisis apartments in three regions of the State, as well as implementation of a transition planning process designed to inform individuals of opportunities for community living while addressing and overcoming barriers to discharge.
Additionally, the State will develop and implement a quality assurance and performance improvement system to ensure community services provide reasonable opportunities to help individuals achieve increased independence, be more integrated into their communities, and avoid unnecessary institutionalization.
An independent Expert Reviewer will be selected to oversee the five year implementation process, and to measure compliance with the terms of the Agreement. Among the Expert Reviewer’s responsibilities are convening meetings of the parties, producing public reports on the status of implementation, and mediating potential disputes. The Court will retain jurisdiction over the case and the court-ordered Settlement Agreement until compliance has been fully achieved.
September 17, 2013: In late January 2013, the Center and its co-counsel submitted their renewed motion for class certification in Lynn E. v. Lynch (now captioned Amanda D. v. Hassan), seeking to represent a class of individuals with serious mental illness institutionalized at New Hampshire Hospital or Glencliff nursing home, or at serious risk of institutionalization at these facilities. Extensive legal briefings and the results of six months of class-based discovery were presented to the Court in oral arguments this spring, along with potential revisions to the proposed class definition.
In a lengthy decision issued on September 17, 2013, the Court concluded that class treatment was appropriate and the evidence presented sufficient to conclude that plaintiffs had satisfied the legal criteria for certification. Specifically, plaintiffs’ successfully alleged that systemic deficiencies in the State's community-based mental health services system affected the class as a whole, resulted from a pattern or practice of agency action or inaction, and that the resulting common contention was capable of being remedied by a single injunction.
Consistent with recent Supreme Court rulings, the Court found that the majority of defendants’ objections related not to the requirements of Rule 23, but to their fundamental alteration defense and, therefore, were properly addressed in the trial on the merits. The Court also relied upon, and cited favorably to, Department of JusticeOlmstead guidance, concluding that persons at serious risk of institutionalization were appropriately included in a class harmed by unnecessary institutionalization.
Most notably, the Court’s decision upholds decades of class action, civil rights litigation under Olmstead and on behalf of people with disabilities, concluding that persons with psychiatric disabilities can maintain an injunctive class action despite individual differences in diagnosis, treatment needs or current preferences for community living.
The certified class is defined as:
“All persons with serious mental illness who are unnecessarily institutionalized in New Hampshire Hospital or Glencliff or who are at serious risk of unnecessary institutionalization in these facilities.
At risk of institutionalization means persons who, within a two year period: (1) had multiple hospitalizations; (2) used crisis or emergency room services for psychiatric reasons; (3) had criminal justice involvement as a result of their mental illness; or (4) were unable to access needed community services."
In late January 2013, the Center and its co-counsel submitted their renewed motion for class certification in Lynn E. v. Lynch (now captioned Amanda D. v. Hassan), seeking to represent a class of individuals with serious mental illness institutionalized at New Hampshire Hospital or Glencliff nursing home, or at serious risk of institutionalization at these facilities. The renewed motion was accompanied by a detailed Memorandum and expert affidavits describing the outcome of preliminary client and system reviews. The memo argued that the defendants’ administration, planning and funding of its community mental health system failed to prevent unnecessary institutionalization, resulting in a common contention susceptible to, and able to be resolved by, a single injunction.
The defendants responded with an 80 page opposition, over 70 pages of affidavits, and hundreds of pages of class member medical records, arguing that differences among class members’ service needs and preferences made class certification inappropriate. They also challenged the class definition because it contained an “at risk” group.
The Reply focused on the recent Supreme Court decision in Amgen v.Connecticut Retirement Board, 568 U.S. __, 2013 WL 691001 *4 (February 27, 2013) and its admonishment that class certification decisions not become a “mini trial” on the merits.
Oral argument before the federal court is anticipated later this spring.
February 9, 2012: Lynn E. v. Lynch
Six individuals filed this class action on behalf of themselves and all persons with serious mental illness who are institutionalized in the New Hampshire Hospital (NHH) or the Glencliff Nursing Home (Glencliff), or at serious risk of institutionalization in these state-operated facilities. New Hampshire has failed to provide the community services that the plaintiffs need to leave NHH and Glencliff and to prevent their unnecessary institutionalization in these facilities. These services include: mobile crisis intervention, Assertive Community Treatment, supported housing, and supported employment.
The plaintiffs request declaratory and injunctive relief under Title II of the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and the Nursing Home Reform Amendments to the Medicaid Act, as well as an order directing the State to provide community services required to avoid class members’ needless institutionalization.
The U.S. Department of Justice also conducted an investigation of NH's mental health system. Findings issued in April 2011 concluded that New Hampshire is violating the Americans with Disabilities Act and Olmstead v. L.C., 527 U.S. 581(1999) by failing to provide services to individuals with serious mental illness in the most integrated setting appropriate to their needs. The United States found that this failure “has led to the needless and prolonged institutionalization of individuals with disabilities...” and that the “systemic failures in the State’s system place qualified individuals with disabilities at risk of unnecessary institutionalization now and going forward.”
Other Mental Health Areas of Interest:
April 26, 2012: Advocates Object to Use of Restraint Chair in MA
CPR and other legal advocacy agencies have joined together to object to Massachusetts DMH's plans to use a restraint chair at a soon to be opened state mental hospital. The advocates have written to the DMH Commissioner asking her to reconsider and have branded the restraint device as dangerous and demeaning. Read the letter and bibliography supporting the advocates' arguments.
CPR represented the respondent in an appeal from the denial of his request for an emergency hearing after he alleged "abuse or misuse" of the Massachusetts temporary involuntary civil commitment process. The respondent had been involuntarily readmitted to the hospital within minutes after a court had ordered him discharged. Massachusetts statutes allow individuals to immediately challenge temporary commitments without having to wait for the civil commitment hearing.
In a 2-1 decision the Appellate Division of the District Court affirmed the trial court's refusal to hold an emergency hearing. The respondent appealled and the Supreme Judicial Court has accepted direct review. A copy of the SJC principal brief (Jan 2008) is available below and followed by a link to the appellant's Reply Brief.
September, 2008: Restraint radio program
March 18, 2008: Comments on MA DMH Risk Management Report
This monograph by CPR staff explains the complex web of rules regarding the restraint and seclusion of children and adolescents in various hospital and residential settings in Massachusetts: Restraint of Children in Massachusetts -- A monograph
April 5, 2004
The documents contained on this page and within this web site do not constitute legal advice. Anyone engaged in legal action should consult with an attorney. Attorneys should make their own independent judgments. Local laws vary and the law may have changed since these documents were written. Litigants should fully research any claims or defenses before making them.