The report shows that thousands of Missourians with mental health issues are being held against their will

Thousands of Missourians with mental health issues are needlessly being held in nursing homes against their will due to systemic state failures, according to a searing report from the Department of Justice.

Most of the more than 3,000 people eligible for Medicaid require little or no physical assistance. About half are younger than 65 years old. Yet many of them have been stuck in nursing homes for more than three years.

“It is virtually universal that adults with mental health problems in Missouri’s nursing homes do not want to live in these facilities,” the report said. “They dream of a life integrated into the community, in accordance with the requirements of the Americans with Disabilities Act (ADA). They want to enjoy simple pleasures of everyday life, such as going to a fair, spending time with friends and family, having a pet, working, and simply being ‘independent’.”

The investigation began in 2022 after the Justice Department received a complaint that Missouri was unnecessarily confining people with mental health problems to nursing homes — often clustered in just 39 homes. The investigators found that the state violated the ADA because it separated people from their communities.

There are three agencies responsible for caring for people with mental health conditions living in nursing homes: the Department of Social Services, the Department of Health and Senior Services, and the Department of Mental Health.

Spokespeople for the agencies said they are currently reviewing the report.

The 45-page report says the agencies have failed to take advantage of federal programs that provide resources to help people with mental health issues stay in their communities — including programs that help with employment, housing and peer services.

“Missouri has made deliberate policy choices that result in the unnecessary admission of people with mental health conditions to nursing facilities,” the report said.

Instead, people often flow in and out of psychiatric hospitals until the state appoints a guardian — where someone is appointed by a court to make decisions about housing and treatment for someone deemed unable to get food or shelter or their own to protect. safety – which then places them in a nursing home. Missouri has a higher percentage of people with bipolar disorder or schizophrenia in nursing homes than most other states.

Overuse of guardianship

Often, the state relies on guardianship as the easiest step when someone repeatedly refuses treatment for their mental health disability. Guardianships are extremely difficult to undo, which has resulted in thousands of Missourians losing control over their own decisions.

“When a person with a mental health disability is under guardianship, their experience in a nursing facility is even more isolating,” the report said. “Nursing facilities provide guardians with the ability to restrict a wide range of activities, including activities (such as their communications) that Missouri law does not allow guardians to restrict.”

Government administrators, who are often responsible for taking on the guardianship of people who have no adult to intervene, are often overburdened. Government officials in Missouri are responsible for an average of 91 people, far higher than the industry standard of one guardian for every 20 people.

“High workloads and limited staff mean there is little time to support each of the people under guardianship,” the report said. “We spoke to nursing home residents who told us that they had not seen their guardians for years and that guardians do not return calls or are otherwise unavailable to speak with them.”

The Justice Department ruled that Missouri’s system was intentional. Instead of providing community resources that can help people with intellectual disabilities integrate into their communities, the state has created a system that helps push people into nursing homes.

Now that the report has been released, the Department, Justice Department, and the state can work together in an effort to bring state policy into compliance with the ADA. If the state fails to act, the Justice Department could file a lawsuit in federal court.

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