Olmstead Plan Brief (PDF)

Make Minnesota a place where all people have meaningful choice and fair opportunities for a good life.

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Supporting People with Mental Illness to Lead
Meaningful Lives in their Community:
Choices and fairness for all citizens
Policy Brief – February 2014
Authors: Jeni Kolstad, Rojina McCarthy, Ann Przybilla, Abby Sharp

Executive Summary
Minnesota’s  state  leadership  values  the  health  and  
well-­‐being  of  all  its  citizens.  This  is  demonstrated  by      
Governor  Dayton’s  Executive  Order  establishing  a  
sub-­‐cabinet  to  develop  and  implement  a  
comprehensive  plan  supporting  freedom  of  choice  
and  opportunity  for  people  with  disabilities  –  
referred  to  as  the  Olmstead  Plan.  
People  who  are  diagnosed  with  serious  and  
persistent  mental  illnesses  (SPMI)  are  Minnesotans  
with  disabilities  that  struggle  for  many  of  the  ideals  
outlined  in  the  Olmstead  Plan:  
•

•
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Opportunity  and  freedom  for  meaningful  
choice,  self-­‐determination,  and  increased  
quality  of  life  
Opportunities  for  economic  self-­‐sufficiency  
Employment  options  
Choices  of  living  location  and  situation  
Supports  needed  to  realize  these  choices  

Unfortunately,  Minnesota  has  largely  left  out  
people  with  SPMI  from  the  Olmstead  Plan.  
Minnesota’s  Olmstead  Plan  is  a  work  in  progress.      
The  time  is  now  to  voice  concerns  about  the  lack  of  
attention  to  people  with  SPMI  in  the  plan.    It  is  
imperative  that  the  Olmstead  Plan  address  the  
unique  needs  and  challenges  of  people  with  SPMI  
and  ensure  that  the  approaches  taken  are  designed  
to  meet  their  needs.  
 

The Americans with Disabilities Act
defines a “disability” as a person who:
•

Has  a  physical  or  mental  impairment  that  
limits  one  or  more  major  life  activities    

•

Has  a  record  of  such  impairment  

•

Or  is  regarded  as  having  such  impairment1  

What is Minnesota’s Olmstead Plan?
•

A  way  for  the  state  to  document  its  plans  to  
provide  services  to  individuals  with  disabilities  
in  the  most  integrated  setting  appropriate  to  
the  individual.  

•

Goals  are  related  to  employment,  housing,  
transportation,  supports  and  services,  lifelong  
learning  and  education,  healthcare  and  
healthy  living,  and  community  engagement  for  
people  with  disabilities.  

• It  aims  at  “achieving  a  Better  Minnesota  for  all  
the  Minnesotans,  and  strives  to  ensure  that  
Minnesotans  with  disabilities  will  have  the  
opportunity,  both  now  and  in  the  future,  to  
live  close  to  their  families  and  friends,  to  live  
more  independently,  to  engage  in  productive  
employment  and  to  participate  in  community  
life.”  2  

People who live with a serious and persistent mental illness
are citizens with disabilities who deserve support.
This policy brief was developed & disseminated in collaboration with the Department of Social work at Minnesota State University, Mankato

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Make Minnesota a place where all people have meaningful choice and fair opportunities for a good life.

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Understanding Mental Illness
Mental  illness  is  a  medical  condition  that  
interferes  with  a  person’s  thinking,  feeling,  and  
mood.    Mental  illness  can  greatly  affect  the  daily  
functioning  of  people.    Just  as  physical  medical  
conditions  can  be  relieved  through  medical  
treatment,  so  can  mental  illnesses.  Mental  
illness  can  affect  anyone  regardless  of  age,  
gender,  race,  or  income.    The  symptoms  of  
mental  illness  can  be  disabling,  in  particular  for  
people  with  a  SPMI,  where  people  may  not  be  
able  to  work  or  take  care  of  themselves  without  
support.  Unfortunately,  there  just  is  not  enough  
support  for  people  with  SPMI  to  live  healthy  
lives  within  the  community.  The  Olmstead  plan  
was  developed  in  Minnesota  to  provide  
additional  supports  for  people  with  conditions  
that  result  in  a  disability.3  

When Mental Illness is a Disability
People  who  have  serious  and  persistent  mental  
Illness  (SPMI)  can  qualify  as  having  a  disability  
due  to:  
•

Frequent  inpatient  care  

•

Psychiatric  hospitalizations  

•

Impairment  in  functioning  in  major  life  
activities  

•

A  diagnosis  of  schizophrenia,  bipolar  
disorder,  major  depression,  schizoaffective  
disorder,  or  borderline  personality  disorder  

 
Services That Support People with SPMI
to Live in their Community
•

Adult  Rehabilitative  Mental  Health  Services  
(ARMHS)  

•

Intensive  Residential  Treatment  Services  
(IRTS)  

•

Assertive  Community  Treatment  (ACT)  

•

Community  Behavioral  Health  Hospitals  
(CBHH)  

•

Crisis  Response  Teams  (CRT)  

•

Crisis  Residential    

About 320,000 adults in Minnesota each year have a mental illness,
with 167,000 adults having a Serious and Persistent Mental Illness.
It is estimated that less than 50% of people with SPMI receive the
treatment they need. 4

This policy brief was developed & disseminated in collaboration with the Department of Social work at Minnesota State University, Mankato

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Make Minnesota a place where all people have meaningful choice and fair opportunities for a good life.

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Limitations of the Olmstead
Plan for People with SPMI
While  the  Olmstead  Plan  provides  
recommendations  for  individuals  with  a  disability,  
it  does  not  appropriately  address  the  needs  of  
people  with  a  serious  and  persistent  mental  
illness.    Time  and  again  we  have  seen  services  and  
supports  designed  from  the  perspective  of  serving  
people  with  developmental  or  physical  disabilities,  
as  a  result,  failing  to  meet  the  needs  of  people  
with  SPMI,  often  with  detrimental  effects.    People  
with  SPMI  have  unique  needs  and  challenges  that  
require  services  designed  to  meet  their  specific  
needs,  not  to  be  grouped  with  others  using  a  “one  
size  fits  all  approach.”  
Missing  from  the  Olmstead  Plan,  which  would  
better  address  the  needs  of  people  with  mental  
illness,  are  services  such  as:  
•
•
•
•

Adult  Rehabilitative  Mental  Health  Services  
(ARMHS)  
Intensive  Residential  Treatment  Services  (IRTS)  
Assertive  Community  Treatment  (ACT)  
Crisis  Residential    

The  Plan  makes  mention  of  the  need  to  offer  
supports  in  an  integrated  way,  although  none  of  
the  recommendations  fully  provide  the  supports  
necessary  for  this  population.    Mental  health  
providers  and  advocates  are  aware  of  the  need  
for  readily  available  psychiatric  services;  however,  
the  Olmstead  Plan  does  not  include  a  strategy  for  
shortening  wait  times.  

Real People: Real Costs
The  story  of  “Tony”  epitomizes  the  unique  set  of  
challenges  he  faces  each  day  just  to  live  
independently  in  his  apartment;  an  integrated  
setting.    Tony  receives  services  from  ARMHS  on  a  
weekly  basis  and  has  also  received  care  from  
facilities  such  as  the  CBHH  and  IRTS.    He  has  also  
had  two  previous  stays  at  the  crisis  center  in  his  
community.    In  order  for  Tony  to  continue  to  live  
successfully  in  his  apartment,  he  requires  these  
services,  which  are  designed  to  assist  him  to  cope  
with  the  many  challenges  he  faces  including:  
•

Isolation  

•

Low  motivation  

•

Energy  loss  

•

Feelings  of  hopelessness  and  helplessness  

•

Thoughts  of  self-­‐harm  

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Engagement  in  self  destructive  behaviors  

•

Challenges  maintaining  relationships  

•

Flashbacks  from  his  tragic  past    

Tony  experiences  minor  relapses  in  his  symptoms,  
just  like  many  others.    However,  with  the  
supportive  mental  health  services  he  receives,  he  
is  able  to  cope  with  his  disability  and  live  a  good  
quality  of  life.    Tony  often  comments  that  without  
the  help  he  receives,  living  independently  would  
not  be  a  realistic  goal  and  his  ability  to  live  a  
meaningful  life  as  a  member  of  his  community  
would  be  impossible.      

Finally,  the  Plan  does  not  address  the  need  to  
 
expand  service  options,  including  Evidence  Based  
Practices  (EBP).    The  Olmstead  Plan  does  not  
include  any  EBP  approaches  to  reach  their  goal  of  
moving  “consumers”  to  an  integrated  setting.    
Integrated community services has been demonstrated to reduce
psychiatric hospitalizations by more than 70% 5

This policy brief was developed & disseminated in collaboration with the Department of Social work at Minnesota State University, Mankato

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Make Minnesota a place where all people have meaningful choice and fair opportunities for a good life.

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Recommendations
In  order  to  improve  Minnesota’s  Olmstead  Plan  
to  better  meet  the  needs  of  people  with  SPMI,  
the  following  changes  are  needed  in  the  Plan:
•

Explicitly  discuss  and  address  the  needs  of  
people  with  serious  and  persistent  mental  
illness.  

•

A  clear  definition  of  “Serious  and  Persistent  
Mental  Illness”  as  a  disability.  

•

Add  specific  services  such  as  ARMHS,  IRTS,  
ACT,  CBHH,  CRT,  and  Crisis  Residential  

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Include  information  about  “mental  illness”  
and  “SPMI”  in  the  demographics  data.  

•

Address  the  lack  of  psychiatric  care,  
especially  in  rural  areas.  

•

Provide  transitional  housing  supports.  

•

Address  the  number  of  people  with  SPMI  
incarcerated  due  to  lack  of  services.  

 
 

Minnesotans with disabilities
should “live with dignity, be valued
members of their communities, and
make choices to improve the
quality of their own lives.”
Minnesota Governor Mark Dayton
November 1, 20136

Your Call to Action.
The Time is Now!
The  Olmstead  Plan  is  not  static.    A  revised  
version  will  be  released  in  July  2014.    The  time  
is  now  to  voice  concern  that  the  needs  of  
people  with  SPMI  are  not  adequately  
addressed  in  the  plan.  The  Olmstead  Planning  
Committee  acknowledged  that  there  are  areas  
they  could  not  address  due  to  lack  of  
knowledge,  so  they  need  mental  health  
providers,  advocates,  and  consumers  of  mental  
health  services  to  share  their  knowledge,  
expertise,  and  experiences  with  the  committee.  
 

What  you  can  do:  
• Learn  more  about  the  Olmstead  Plan  by  
going  to:  www.dhs.state.mn.us/Olmstead/  
Sources  
1.  Americans  with  Disabilities  Act  1990,  P.L.  110-­‐325, Section  10102.  
2.  Olmstead  Planning  Committee,  Putting  the  Promise  of  Olmstead  
into  Practice  (2013).  
3.  NAMI,  Mental  Illnesses  (n.d.).  
4.  SAMSHA,  Behavioral  Health  Monitor:  Minnesota  (2013).  
5.  Treatment  Advocacy  Center,  Eliminating  Barriers  to  the  Treatment  
of  Mental  Illness  (2011).  
6.  Office  of  Governor  Mark  Dayton,  Statement  from  Governor  Mark  
Dayton  on  Minnesota’s  Olmstead  Plan  (2013).  

 

For  more  information,  email  the  authors  of  this  brief  at  
abby.sharp@mnsu.edu  

• Notify  the  Olmstead  Implementation  Office  
about  these  recommendations  by  emailing  
them  at  opc.public@state.mn.us  
Contact  your  local  legislators  and  inform  
them  of  the  gaping  holes  in  the  plan  
http://www.leg.state.mn.us/leg/districtfin
der.aspx  

•

 
 

This policy brief was developed and disseminated in collaboration with the Department of Social Work at Minnesota State University, Mankato 4

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