SC keeps the mentally ill in group homes. That might violate federal law, new report finds

South Carolina must change the way it cares for people in the state living with a serious mental illness, following a federal investigation.

The U.S. Department of Justice recently found that South Carolina likely violates federal law by failing to provide individuals with serious mental illness the opportunity to live at home while receiving support services. Instead, patients are often packed for years into community residential care facilities — so-called adult care homes — which are generally isolated from ordinary community life, according to the report.

“[T]here’s no vision of ever getting out,” a state employee told federal investigators. “There’s no vision of having a real life… There’s no vision of anything. They just feel stuck.”

The Palmetto State must now refrain from warehousing people with serious mental disabilities in segregated group homes, by creating a pathway for these patients to live independently in their own homes with access to community-based services, such as employment and peer support. If the department fails in this regard, it could face a federal lawsuit, according to the report.

“Because of deficiencies in its community-based service array and the manner in which the State administers its adult mental health system, the State relies on segregated settings to serve adults with serious mental illness who could be served in their homes and communities,” the report concluded.

The federal investigation was spurred by a complaint filed by advocacy group Disability Rights South Carolina in late 2021.

The Department of Mental Health has acknowledged the deficiencies highlighted in the report and are set to begin negotiations with Justice officials next month.

Mental Health spokesperson Tracy LaPointe said the department will discuss expanding its community services with the Justice Department, the state’s Medicaid agency, patients, families and other stakeholders.

South Carolina mental health system consists of two state agencies, including the Department of Mental Health and the Department of Health and Human Services. Mental Health is responsible for directly providing services for people with serious mental illness, while the health department funds services and housing for patients.

There are approximately 2,000 people with a serious mental illness residing in group homes in South Carolina, according to the report.

Adult care homes in South Carolina are used to provide room, board and personal care to thousands of people with serious mental illness or other disabilities, according to the report. Adult care home staff generally prepare meals for the residents, distribute medication and maintain the facility’s cleanliness.

There are around 450 adult care homes licensed in South Carolina by the Department of Health and Environmental Control. The Department of Mental Health manages two adult psychiatric hospitals and eight group homes. The department also maintains a “working relationship” with approximately 60 group homes, according to LaPointe.

Anna Maria Connor, a senior attorney for the advocacy group that brought the federal complaint, said problems have existed for years within South Carolina’s mental health care system, but she credited the Department of Mental Health for continuing to make efforts to improve its care of people living with serious mental illness and disability.

“There’s a place in in the system for (adult care homes), but we think that unfortunately, a lot of people with disabilities, particularly those with mental illness, get stuck there,” Connor said. “And so we wanted to get some help to try and see if we can address that issue, and to change the structural system to make it easier for people to be able to move and transition as appropriate and as they wish to do.”

The Department of Justice contends that South Carolina is likely violating Title II of the American with Disabilities Act in its practice of filling group homes.

The ADA “requires public entities to provide community-based services to people with disabilities when such services are appropriate; the affected people do not oppose community-based services; and community-based services can be reasonably accommodated,” according to the 1999 Supreme Court decision in Olmsted v. L.C.

But instead of using its resources to help facilitate independent community-based living for people with serious mental illness, South Carolina continues to invest in and promote the use of group homes, the federal report said.

The report offers multiple examples of mentally ill residents expressing a desire to leave an adult care home, but who were unable to due to limited support services in South Carolina.

For example, “Mitchell, age 39, has lived in a (adult care home) for seven years,” the report said. “He used to work on a farm; he ‘loved it—that’s my world right there.’ He wants to work, and to live independently with appropriate services, but he did not report receiving any outreach from the State to be considered for such a transition.”

LaPointe said the COVID-19 pandemic served as a catalyst for some of the issues raised by the report.

“SCDMH agrees that the availability of some of its intensive community services varies across the state, primarily due to a serious shortage of staff,” LaPointe said. “Increasing the availability of mental health services, including those needed by people with serious mental illness, requires additional trained professional staff.”

To that end, Mental Health requested that legislators help increase state employee salaries in this year’s state budget. That request was granted.

In this year’s state budget, which runs from July 1 to June 30, 2024 the state Department of Mental Health received around $4 million to increase the salaries of mental health professionals and nearly $5 million for nurses’ pay.

“SCDMH is optimistic that they will bring about improved recruitment and retention. As a result, SCDMH anticipates it will be able to reduce staff vacancies,” LaPointe said. “If this is the case, SCDMH expects the availability of its intensive community services will improve” and allow the department to expand its services outside the adult group home setting.