COLUMBIA, S.C. – The federal government has sued South Carolina, saying the state has not done enough to make sure people with serious mental illnesses are taken out of group homes and helped to get back into the community where they can work and lead independent lives.
The lawsuit filed Monday said the state violates the Americans with Disabilities Act by opting, through money and policy decisions, to leave people with mental illnesses in group homes where they can't choose what to eat, pick their own roommate, find a way to work at a job or go to church and other activities.
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The state has known about the issues since a different 2016 lawsuit and federal officials warned them of the problems and possible legal action in a 23-page report in May 2023, U.S. Justice Department lawyers said in court papers.
“People with disabilities in South Carolina can and must be able to receive services in their own homes, rather than being isolated in institutions,” Kristen Clarke, an assistant attorney in the agency's Civil Rights Division, said in a statement.
While Republican South Carolina Gov. Henry McMaster questioned the timing of the lawsuit, coming in the final weeks of Democratic President Joe Biden's administration, he is working on solutions to the problems brought up in the suit, spokesman Brandon Charochak said in a statement.
One idea is to combine the state Department of Mental Health and the Department of Disabilities and Special Needs and put the new agency in the governor's cabinet under his supervision.
“The fact remains that our state’s healthcare delivery system is fractured with non-cabinet agencies that are unaccountable and inefficient. The governor believes the time to change this is now,” Charochak said.
Federal officials suggested spending more money and making sure the state's Medicaid program makes adequate payments for programs called assertive community treatments.
Under the prgrams, teams visit people with serious mental illnesses in their home. There is at least one psychiatrist, two psychiatric nurses, specialists in employment and substance abuse, and other professionals.
Research has found the teams often can head off a mental health crisis. They also can provide crisis teams that can respond quickly to prevent bigger issues, from police involvement to psychiatric hospital stays, the Justice Department investigation found.
There are only four teams in South Carolina — in Columbia, Greenville and Dillon — and they don't provide statewide coverage. They also have low staffing.
Currently, about 1,000 people live in group homes. A large number of them told federal investigators they wanted to live on their own, but ran into problems.
Federal officials spent months investigating what are officially called community residential care facilities, talking to residents, administrators and people who provide treatment outside the homes for those with mental illnesses who are living independently.
The identities of those who spoke were kept anonymous for their privacy, including one group home resident who pointed out the living conditions weren’t much different than decades ago when people with mental illness were housed in giant centers with no private rooms and little individualized care.
Residents of the group home often only get to leave for a monthly outing to Walmart or Dollar General. They have no way of working because they can’t get transportation to a job. Sometimes the home is fenced in with locked doors and security cameras.
“Something like a little asylum in here,” the resident told investigators.
The homes are required by law to post calendars with activities. Investigators found almost all of them were events inside the home like arts and crafts, “name that tune,” Bible study, bingo, “bubble-blowing fun” and coloring pages, federal officials told the state.
“There’s no vision of ever getting out. There’s no vision of having a real life. … There’s no vision of anything. They just feel stuck. That’s almost like hospitals used to be, 150 years ago,” a state employee who regularly visits one home told investigators.
The report cited the case of a 40-year-old man who lived independently for three years when a break-in at his apartment caused a mental health crisis that led to several months in a psychiatric hospital. He was released to a group home, where he has lived for 11 years. He told investigators he wants to live independently but has been offered no help.
A 43-year-old woman told investigators she had a mental crisis in 2020 and went to a group home because her parents thought it would help her rebuild her independence. Now the parents are trying to get her out because she got no help for living skills.
Others had a financial crisis that coincided with a mental crisis and need help with affordable housing or job skills.