The state agency overseeing mental health must hire more people, including teams to respond to people in crisis, under a settlement agreement with the U.S. Department of Justice. (Photo provided/Department of Mental Health)
COLUMBIA — South Carolina agreed to bolster programs that help people with severe mental illness live on their own as part of a settlement agreement with the federal Department of Justice.
The federal agency sued the state last December, claiming South Carolina’s agencies kept people in restrictive residential housing longer than necessary. People in the state’s care had few opportunities to go out in public or learn necessary social skills, making it difficult to meet the requirements to transition out of state-run facilities and into their own housing, the lawsuit claimed.
Not providing adults with severe mental illness who are capable of taking care of themselves with the supports needed to live on their own violates the 1990 Americans with Disabilities Act, which protects people with disabilities from discrimination, the justice department’s Civil Rights Division argued.
South Carolina, which denied the lawsuit’s claims, did not admit to doing anything wrong. The state has programs in place to address the Department of Justice’s demands, but over the next three years, the Department of Behavioral Health and Developmental Disabilities will expand those programs in an effort to help more people transition out of residential care and, when possible, treat people in their own homes, according to the settlement announced Thursday.
“We are pleased that the parties were able to reach an agreement to resolve this suit,” said Robert Kittle, a spokesman for the state attorney general, in an email.
The agency’s mental health office was pleased with the agreement, spokeswoman Tracy LaPointe said in an email. She noted that the state already meets some of the federal agency’s requirements, which the settlement requires the agency to maintain in the coming years.
“The office looks forward to expanding the identified services as needed to ensure those in need have access to high quality services in the least restrictive setting possible and continue to develop additional resources and partnerships to further this goal,” LaPointe said.
Last year, when the lawsuit was filed, more than 1,000 people were living in the state’s 362 facilities, which are often the first stop for people discharged from state-run psychiatric hospitals, according to the initial complaint. Seven of those were run through the state Office of Mental Health, LaPointe said.
Many of the people living in those care homes could live on their own with the right supports, the lawsuit argued. And some wouldn’t have to go there in the first place if the state had more resources to help people in crisis stay in their homes, federal attorneys wrote.
If the agency doesn’t meet the goals laid out in the agreement, the Department of Justice could sue again, according to the agreement. Since any funding for expanded programs must go through the Legislature, the federal and state agencies will meet to discuss next steps if legislators opt not to fund the programs.
The state’s behavioral health department, which formed this year from three other health-related agencies, is asking for $1.1 million to start putting changes in place. That’s in addition to the $3 million in the state budget that runs through the end of June for similar efforts. The agency expects to make another request for funding for the 2026-2027 budget, according to its budget request.
“The Department and South Carolina are working together to ensure that people with serious mental illnesses can be served in the community when they want to be,” said Harmeet K. Dhillon, an assistant U.S. attorney general, in a news release. “This is a great day for the people of South Carolina and demonstrates the substantial work that can happen when the federal government and states work together.”
Most of the settlement’s requirements had to do with hiring and retaining employees.
Some changes could prevent unnecessary hospitalizations, keeping people from going into residential treatment in the first place, according to the settlement.
For instance, the state must make sure it has at least two dedicated peer support specialists at each of its 16 community centers across the state. The specialists have been through their own recoveries and can share their experiences to help people in similar situations, who may not always trust medical professionals, according to the lawsuit.
The mental health office also needs more teams to visit people’s homes to help them with everyday treatment needs and other daily tasks, according to the settlement. When the lawsuit was filed, the state operated two Assertive Community Treatment teams, composed of nurses, psychiatrists and peer support specialists. It needed another 11, including six larger teams capable of treating upward of 50 clients each, the settlement reads.
The state has 13 teams, LaPointe said, meaning it just needs to maintain staffing to stay in compliance with the order.
For people experiencing mental health emergencies, the state should have more two-person mobile crisis teams, which respond to calls made to 988, the suicide and crisis hotline. For that, the justice department didn’t give a specific number of teams, saying only that the state must have enough to respond to two incidents in a county at a time. The state’s 16 centers have a total of 21 teams, LaPointe said.
If a person does need to stay at a residential treatment center, once they are stable and no longer need around-the-clock care, the state should work to get them back into the community as quickly as possible, according to the agreement.
To keep people from staying in residential care indefinitely, case managers should create a plan for how they will get housing, a job and at-home treatment, if necessary, within a month of a patient deciding they want to leave. No resident should stay longer than three months after they are able to secure housing and any other necessary supports under the agreement.
Adults who prefer residential care don’t have to leave, but they should have that choice, the settlement reads.
