Serving the seriously mentally ill in the “least restrictive alternative”: Issues from a federal court consent decree

Abstract

The last two decades have witnessed numerous legal actions aimed at securing the rights of the mentally disabled to be served in the least restrictive alternative consistent with their needs. This paper examines the effectiveness of a federal court consent decree in placing seriously mentally ill persons in less restrictive settings. The data indicate that, despite a massive investment in community based services in the catchment area affected by the consent decree, persons with serious mental illness in this area are no less likely to be situated in some type of supervised setting (including hospitals, residential programs, and nursing homes) than are those in non-affected areas. These data question the extent to which the original goal of the consent decree, to create a service system that would result in many persons living independently in the community, was realized. The data also call for a rethinking of the issue of restrictiveness in the design of similar efforts in the future. An earlier version of this paper was presented at the Annual Meeting of the American Public Health Association, Washington, DC, in November 1992.